Healthcare Provider Details

I. General information

NPI: 1003491788
Provider Name (Legal Business Name): WILLIAM SCOTT HENRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 HANCOCK VILLAGE ST
CHESTERFIELD VA
23832-2776
US

IV. Provider business mailing address

9507 SPENDTHRIFT CIR APT 213
HENRICO VA
23294-5312
US

V. Phone/Fax

Practice location:
  • Phone: 804-739-1668
  • Fax:
Mailing address:
  • Phone: 804-716-3175
  • Fax: 804-800-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: