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General NPI Number Information
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NPI Number | 1396832101
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Entity Type | Organization
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Legal Business Name | HENDERSON DRUGS, INC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 2021 HOSPITAL DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-7205
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Country | US
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Telephone | 662-624-6591
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Fax | 662-627-3389
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Provider Business Mailing Address
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Address Line | 2021 HOSPITAL DR P O BOX 819
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City | CLARKSDALE
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State | MS
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Zip | 38614-7205
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Country | US
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Telephone | 662-624-6591
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Fax | 662-627-3389
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Authorized Official
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Title or Position | PRES
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Name | VAL SOLDEVILA
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Credential | RPH
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Telephone | 662-624-6591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 00412
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License Number State | MS
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