Active NPI
Roy Hendricksen
- Pharmacist
- San Carlos, CA
National Provider Identifier
1487936639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 32204
- Practice address
- 1414 El Camino Real
San Carlos, CA 94070 - Phone
- (650) 637-9777
- NPI assigned
- Sep 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 32204 | CA | Primary |
Addresses
Primary practice location
1414 El Camino Real
San Carlos, CA 94070
Mailing address
1607 Alameda de Las Pulgas
San Carlos, CA 94070
Phone (650) 364-4858
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 |
|---|---|---|---|
| 32204 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315958400000",
"number": "1487936639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1607 ALAMEDA DE LAS PULGAS",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "94070",
"telephone_number": "650-364-4858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 EL CAMINO REAL",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "94070",
"telephone_number": "650-637-9777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKSEN",
"first_name": "ROY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-14",
"last_updated": "2011-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "32204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Carlos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.