Healthcare Provider Details

I. General information

NPI: 1619188570
Provider Name (Legal Business Name): KIMBERLY MICHELLE HENRY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 DELAWARE AVE
TONAWANDA NY
14217-1122
US

IV. Provider business mailing address

3564 DELAWARE AVE
TONAWANDA NY
14217-1122
US

V. Phone/Fax

Practice location:
  • Phone: 716-873-5348
  • Fax:
Mailing address:
  • Phone: 716-873-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: