Provider Demographics
NPI:1215327028
Name:HENRY, STEPHAINE E (CPHT)
Entity type:Individual
Prefix:
First Name:STEPHAINE
Middle Name:E
Last Name:HENRY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 WINDLESTRAW DR APT 28
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9044
Mailing Address - Country:US
Mailing Address - Phone:336-269-3030
Mailing Address - Fax:
Practice Address - Street 1:8651 BRIER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7325
Practice Address - Country:US
Practice Address - Phone:919-765-0006
Practice Address - Fax:919-213-4673
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146N00000X
NC29644183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic