MEDICARE: GUY HENDRICKS BCPS

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	1835P1200X	Pharmacotherapy Pharmacist	13505	FL

General Provider Information

NPI Number	:	1255332284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY HENDRICKS BCPS

Provider Business Mailing Address
First Line	:	1073 HYACINTH AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-8061
Country	:	US
Telephone Number	:	863-381-2156
Fax Number	:	863-382-6838

Provider Business Practice Location Address
First Line	:	1073 HYACINTH AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-8061
Country	:	US
Telephone Number	:	863-381-2156
Fax Number	:	863-382-6838

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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