Provider Demographics
NPI:1386077907
Name:HENRICHS, DUSTI RENAE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:DUSTI
Middle Name:RENAE
Last Name:HENRICHS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:DUSTI
Other - Middle Name:RENAE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5706 SHAWN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4438
Mailing Address - Country:US
Mailing Address - Phone:308-379-7820
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027067183500000X
NE13945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist