Active NPI
Latham Kirk Hendrickson
- Pharmacist
- Ames, IA
National Provider Identifier
1174240022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 24592
- Practice address
- 2719 Grand Ave
Ames, IA 50010-4659 - Phone
- (515) 232-8284
- NPI assigned
- Oct 21, 2022
- Last updated
- Oct 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 24592 | IA | Primary |
Addresses
Primary practice location
2719 Grand Ave
Ames, IA 50010-4659
Mailing address
3412 Emerald Dr
Ames, IA 50010-8539
Phone (970) 237-1495
Other practice location 1
310 Story St
Boone, IA 50036-3530
Phone (515) 432-4093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24592 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
2719 Grand Ave
Ames, IA 50010
Phone (515) 232-8248
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666310400000",
"number": "1174240022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3412 EMERALD DR",
"city": "AMES",
"state": "IA",
"postal_code": "500108539",
"telephone_number": "970-237-1495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2719 GRAND AVE",
"city": "AMES",
"state": "IA",
"postal_code": "500104659",
"telephone_number": "515-232-8284"
}
],
"practiceLocations": [
{
"address_1": "310 Story St",
"address_purpose": "LOCATION",
"city": "Boone",
"state": "IA",
"postal_code": "500363530",
"country_code": "US",
"telephone_number": "515-432-4093",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HENDRICKSON",
"first_name": "LATHAM",
"middle_name": "KIRK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-21",
"last_updated": "2022-10-21",
"certification_date": "2022-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "24592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ames, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.