Healthcare Provider Details

I. General information

NPI: 1033180914
Provider Name (Legal Business Name): MICHAEL LEE HENDERSON JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W HERON ST
ABERDEEN WA
98520
US

IV. Provider business mailing address

615 NORTH NINTH STREET
MONTESANO WA
98563-2100
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-8743
  • Fax: 360-538-0063
Mailing address:
  • Phone: 360-249-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19639
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: