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General NPI Number Information
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NPI Number | 1851009070
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Entity Type | Individual
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Provider Name | KENYA HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 3601 N BELT LINE RD
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City | SUNNYVALE
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State | TX
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Zip | 75182-9235
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Country | US
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Telephone | 972-226-4342
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Fax |
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Provider Business Mailing Address
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Address Line | 55 NORTHGATE DR
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City | MONROE
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State | LA
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Zip | 71201-2214
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Country | US
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Telephone | 318-789-6898
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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 | 71128
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License Number State | TX
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