Provider Demographics
NPI:1104975010
Name:HINKLE, GARRY JAMES I (RPH)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:JAMES
Last Name:HINKLE
Suffix:I
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21351 E 2240 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:IL
Mailing Address - Zip Code:61814-5083
Mailing Address - Country:US
Mailing Address - Phone:217-442-2365
Mailing Address - Fax:
Practice Address - Street 1:21351 E 2240 NORTH RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:IL
Practice Address - Zip Code:61814-5083
Practice Address - Country:US
Practice Address - Phone:217-442-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist