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General NPI Number Information
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NPI Number | 1457973265
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Entity Type | Individual
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Provider Name | JOCELYN C. HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 1330 AMERIGROUP WAY
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-5144
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Country | US
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Telephone | 303-882-1194
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550691
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City | HOUSTON
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State | TX
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Zip | 77255-0691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 41522
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License Number State | TX
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