Healthcare Provider Details

I. General information

NPI: 1609112309
Provider Name (Legal Business Name): HENRY D WEBSTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 PIEDMONT RD NE SUITE A
ATLANTA GA
30324-4869
US

IV. Provider business mailing address

1874 PIEDMONT RD NE SUITE A
ATLANTA GA
30324-4869
US

V. Phone/Fax

Practice location:
  • Phone: 404-733-6800
  • Fax: 404-733-6880
Mailing address:
  • Phone: 404-733-6800
  • Fax: 404-733-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019854
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: