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General NPI Number Information
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NPI Number | 1851359061
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Entity Type | Individual
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Provider Name | EARL R.. HENDERSON RPH.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 09/22/2007
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Provider Practice Location Address
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Address Line | 220 W CENTRAL AVE
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City | FITZGERALD
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State | GA
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Zip | 31750-2438
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Country | US
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Telephone | 229-423-0521
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 144
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City | CHULA
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State | GA
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Zip | 31733-0144
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Country | US
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Telephone | 229-382-2779
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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 | 009881
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License Number State | GA
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