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General NPI Number Information
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NPI Number | 1891072567
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Entity Type | Individual
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Provider Name | JASON L HENDRICKSON RPH
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Gender | Male
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 675 S WATER ST
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City | PLATTEVILLE
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State | WI
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Zip | 53818-3608
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Country | US
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Telephone | 608-348-7611
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Fax |
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Provider Business Mailing Address
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Address Line | 12475 TAMA RUN LN
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City | DARLINGTON
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State | WI
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Zip | 53530-9649
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Country | US
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Telephone | 608-776-2403
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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 | 13095-040
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License Number State | WI
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