Provider Demographics
NPI:1619581022
Name:HENDRICKSON, MARK ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:ANDREW
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:415 BROWNS DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8396
Mailing Address - Country:US
Mailing Address - Phone:740-704-3431
Mailing Address - Fax:740-982-3081
Practice Address - Street 1:120 S BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-1015
Practice Address - Country:US
Practice Address - Phone:740-982-3081
Practice Address - Fax:740-982-3301
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03217758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist