Healthcare Provider Details

I. General information

NPI: 1639089063
Provider Name (Legal Business Name): JUDE A. HENRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12990 CORTEZ BLVD
BROOKSVILLE FL
34613-6803
US

IV. Provider business mailing address

14496 GOLDENEYE RD
WEEKI WACHEE FL
34614-1579
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: