Healthcare Provider Details

I. General information

NPI: 1104708387
Provider Name (Legal Business Name): HENRIETTA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CLAY ST
NOCONA TX
76255-2104
US

IV. Provider business mailing address

216 CLAY ST
NOCONA TX
76255-2104
US

V. Phone/Fax

Practice location:
  • Phone: 940-825-3226
  • Fax:
Mailing address:
  • Phone: 940-825-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK MATHEWS
Title or Position: PRESIDENT/OWNER
Credential: RPH
Phone: 940-538-4361