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General NPI Number Information
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NPI Number | 1487202024
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Entity Type | Individual
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Provider Name | CLARENCE EDWARD HENLEY III PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 834 BARNES CROSSING RD
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City | TUPELO
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State | MS
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Zip | 38804-0909
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Country | US
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Telephone | 662-840-8462
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Fax |
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Provider Business Mailing Address
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Address Line | 20116 OLD HIGHWAY 8
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City | ABERDEEN
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State | MS
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Zip | 39730-9534
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Country | US
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Telephone | 662-436-7181
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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 | E-16068
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License Number State | MS
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