MEDICARE: LAURA HENDRICK

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	14999	AL

General Provider Information

NPI Number	:	1710394887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HENDRICK

Provider Business Mailing Address
First Line	:	101 S UNION ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-3022
Country	:	US
Telephone Number	:	334-263-8460
Fax Number	:	334-263-8660

Provider Business Practice Location Address
First Line	:	101 S UNION ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-3022
Country	:	US
Telephone Number	:	334-263-8460
Fax Number	:

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/22/2014

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