Provider Demographics
NPI:1699246462
Name:HENWOOD, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:HENWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18427-0850
Mailing Address - Country:US
Mailing Address - Phone:570-689-5231
Mailing Address - Fax:570-689-4705
Practice Address - Street 1:116 SIMONS RD
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-9524
Practice Address - Country:US
Practice Address - Phone:570-604-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035377L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist