Provider Demographics
NPI:1285810234
Name:HENNINGSON, WILLIAM NICHOLAS (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:NICHOLAS
Last Name:HENNINGSON
Suffix:
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 1:22 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-1316
Mailing Address - Country:US
Mailing Address - Phone:585-728-2350
Mailing Address - Fax:585-728-9862
Practice Address - Street 1:22 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-1316
Practice Address - Country:US
Practice Address - Phone:585-728-2350
Practice Address - Fax:585-728-9862
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist