Provider Demographics
NPI:1962570945
Name:HENDERSON PHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:HENDERSON PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-702-1181
Mailing Address - Street 1:186 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3106
Mailing Address - Country:US
Mailing Address - Phone:740-702-1181
Mailing Address - Fax:740-702-1190
Practice Address - Street 1:186 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3106
Practice Address - Country:US
Practice Address - Phone:740-702-1181
Practice Address - Fax:740-702-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0619183Medicaid
OH3645073OtherNABP
OH3645073OtherNABP