Healthcare Provider Details

I. General information

NPI: 1619295318
Provider Name (Legal Business Name): ROSALYN HENLEY R.PH., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 CLARKSON AVE PHARMACY DEPARTMENT
BROOKLYN NY
11203-2125
US

IV. Provider business mailing address

681 CLARKSON AVENUE, PHARMACY DEPARTMENT KINGSBORO PSYCHIATRIC CENTER
BROOKLYN NY
11203-2125
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-7386
  • Fax: 718-221-7330
Mailing address:
  • Phone: 718-221-7386
  • Fax: 718-221-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number36536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: