Provider Demographics
NPI:1396353900
Name:HENRY, JENNY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 LAKE HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7997
Mailing Address - Country:US
Mailing Address - Phone:719-649-2496
Mailing Address - Fax:
Practice Address - Street 1:904 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1402
Practice Address - Country:US
Practice Address - Phone:513-934-1212
Practice Address - Fax:513-934-1521
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist