Provider Demographics
NPI:1871826750
Name:HENDRICKS, JOSEPH M (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:HENDRICKS
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 1:550 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5699
Mailing Address - Country:US
Mailing Address - Phone:206-320-2484
Mailing Address - Fax:206-320-4568
Practice Address - Street 1:550 16TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5699
Practice Address - Country:US
Practice Address - Phone:206-320-2484
Practice Address - Fax:206-320-4568
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist