Provider Demographics
NPI:1427689272
Name:HENKE-ROSE, CEDRIC (PHARMD)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:HENKE-ROSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N MAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6953
Mailing Address - Country:US
Mailing Address - Phone:405-843-6691
Mailing Address - Fax:405-848-3591
Practice Address - Street 1:3401 N MAY AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6953
Practice Address - Country:US
Practice Address - Phone:405-843-6691
Practice Address - Fax:405-848-3591
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist