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General NPI Number Information
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NPI Number | 1629084496
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Entity Type | Individual
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Provider Name | JENELL LYN HENSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 11565 SW PACIFIC HWY
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City | TIGARD
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State | OR
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Zip | 97223-8845
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Country | US
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Telephone | 503-293-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 17275 SW RIVENDELL DR
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City | PORTLAND
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State | OR
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Zip | 97224-7626
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Country | US
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Telephone | 503-547-3143
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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 | RPH-0011267
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0011267
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License Number State | OR
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