Provider Demographics
NPI:1598365918
Name:HENDRICKS, CAMBREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAMBREA
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16844 POORBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9236
Mailing Address - Country:US
Mailing Address - Phone:309-645-0768
Mailing Address - Fax:
Practice Address - Street 1:3320 VETERANS DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-9319
Practice Address - Country:US
Practice Address - Phone:309-353-2995
Practice Address - Fax:309-353-5370
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist