Healthcare Provider Details

I. General information

NPI: 1770633703
Provider Name (Legal Business Name): HENRIETTA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N BRIDGE ST
HENRIETTA TX
76365-2804
US

IV. Provider business mailing address

124 N BRIDGE ST
HENRIETTA TX
76365-2804
US

V. Phone/Fax

Practice location:
  • Phone: 940-538-4361
  • Fax: 940-538-6345
Mailing address:
  • Phone: 940-538-4361
  • Fax: 940-538-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24672752243
License Number StateTX

VIII. Authorized Official

Name: MARK MATHEWS
Title or Position: PHARMACIST
Credential:
Phone: 940-538-4361