MEDICARE: ADAM HENDRICKS DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18124	OK

General Provider Information

NPI Number	:	1124780960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM HENDRICKS DPH

Provider Business Mailing Address
First Line	:	1800 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2813
Country	:	US
Telephone Number	:	580-279-1416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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Directions to “ ADAM HENDRICKS DPH” Practice Location

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