Healthcare Provider Details

I. General information

NPI: 1356262083
Provider Name (Legal Business Name): XANDER VAN HENDRICKSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 PARIS RD
MAYFIELD KY
42066-4989
US

IV. Provider business mailing address

39 LALLA LN
MAYFIELD KY
42066-4967
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-2280
  • Fax: 270-247-2559
Mailing address:
  • Phone: 270-705-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025884
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: