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General NPI Number Information
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NPI Number | 1013290105
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Entity Type | Individual
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Provider Name | MARTY LEE HENDRICK PHARM D
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Gender | Male
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Dates
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Enumeration Date | 09/24/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4961 LONG BEACH RD SE
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City | SOUTHPORT
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State | NC
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Zip | 28461-8152
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Country | US
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Telephone | 910-457-9566
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Fax | 910-457-9566
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Provider Business Mailing Address
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Address Line | 4961 LONG BEACH RD SE
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City | SOUTHPORT
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State | NC
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Zip | 28461-8152
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Country | US
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Telephone | 910-457-9566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26880
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13854
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License Number State | OK
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