Provider Demographics
NPI:1013290105
Name:HENDRICK, MARTY LEE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:LEE
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 LONG BEACH RD SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8152
Mailing Address - Country:US
Mailing Address - Phone:910-457-9566
Mailing Address - Fax:
Practice Address - Street 1:4961 LONG BEACH RD SE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8152
Practice Address - Country:US
Practice Address - Phone:910-457-9566
Practice Address - Fax:910-457-9566
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26880183500000X
OK13854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist