Healthcare Provider Details

I. General information

NPI: 1407517972
Provider Name (Legal Business Name): HENDERSON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 N MAIN ST
HENDERSON NE
68371-9798
US

IV. Provider business mailing address

PO BOX 711
HENDERSON NE
68371-0711
US

V. Phone/Fax

Practice location:
  • Phone: 402-723-4475
  • Fax: 402-723-4476
Mailing address:
  • Phone: 402-723-4475
  • Fax: 402-723-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RANDY GLEN BALDWIN
Title or Position: PIC
Credential: PHARMD
Phone: 402-723-4475