Provider Demographics
NPI:1588947832
Name:HENDERSHOT, ELLEN LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LYNN
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8127 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4550
Mailing Address - Country:US
Mailing Address - Phone:812-401-5825
Mailing Address - Fax:812-401-5825
Practice Address - Street 1:925 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4107
Practice Address - Country:US
Practice Address - Phone:812-474-0055
Practice Address - Fax:812-474-0055
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012811183500000X
OH03113043183500000X
AZS008262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist