Healthcare Provider Details

I. General information

NPI: 1578837035
Provider Name (Legal Business Name): BYRON BOYD HENLEY JR. DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 MARKET STREET
HORSESHOE BEND AR
72512
US

IV. Provider business mailing address

404 MARKET STREET
HORSESHOE BEND AR
72512
US

V. Phone/Fax

Practice location:
  • Phone: 870-670-5098
  • Fax: 870-670-5905
Mailing address:
  • Phone: 870-670-5098
  • Fax: 870-670-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD09239
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: