Provider Demographics
NPI:1902636376
Name:HENDRYX, IAN MATTHEW
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:MATTHEW
Last Name:HENDRYX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E MARKET AVE # HU14102
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72149-5615
Mailing Address - Country:US
Mailing Address - Phone:870-250-9500
Mailing Address - Fax:
Practice Address - Street 1:2806 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4776
Practice Address - Country:US
Practice Address - Phone:501-278-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
ARPI23507390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183700000XPharmacy Service ProvidersPharmacy Technician