Provider Demographics
NPI:1811365067
Name:HENDRIX, KIM ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:ROBERT
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-8436
Mailing Address - Country:US
Mailing Address - Phone:231-627-4337
Mailing Address - Fax:231-627-2429
Practice Address - Street 1:1150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2223
Practice Address - Country:US
Practice Address - Phone:231-627-4337
Practice Address - Fax:231-627-2429
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19469183500000X
MI5302023724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist