Provider Demographics
NPI:1912154055
Name:HENRY PHARMACIES INC
Entity type:Organization
Organization Name:HENRY PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-2500
Mailing Address - Street 1:1442 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1027
Mailing Address - Country:US
Mailing Address - Phone:618-283-2500
Mailing Address - Fax:
Practice Address - Street 1:1442 N 8TH ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1027
Practice Address - Country:US
Practice Address - Phone:618-283-2500
Practice Address - Fax:618-283-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1482354OtherNCPDP
IL=========001Medicaid
IL1482354OtherNCPDP
IL6178490001Medicare NSC