Provider Demographics
NPI:1538202163
Name:HENDRICK, MARK GALEN (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:GALEN
Last Name:HENDRICK
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 1:6368 CATSPAW TER
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-7884
Mailing Address - Country:US
Mailing Address - Phone:315-699-6295
Mailing Address - Fax:315-471-4155
Practice Address - Street 1:300 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3257
Practice Address - Country:US
Practice Address - Phone:315-471-4139
Practice Address - Fax:315-471-4155
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist