Kevin L Hendrick, RPH
Individual provider Active NPI Pharmacist · Wood River, IL
NPI 1033217427 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1033217427
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- Practice address
- 600 E Ferguson Ave
Wood River, IL 62095-2146 - Phone
- (618) 254-6223
- Fax
- (618) 254-1772
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051-034394 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camp Drugs, Inc | Pharmacist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | IL | Yes |
Addresses
Primary practice location
600 E Ferguson Ave
Wood River, IL 62095-2146
Mailing address
5 Cobblestone CT
Granite City, IL 62040-5183
Phone (618) 451-7665
Other providers in Wood River, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.