Healthcare Provider Details

I. General information

NPI: 1013272632
Provider Name (Legal Business Name): JESSICA MARIE HENRY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

V. Phone/Fax

Practice location:
  • Phone: 814-883-9026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP444055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: