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General NPI Number Information
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NPI Number | 1891943544
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Entity Type | Individual
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Provider Name | CALLISTA M HENSON R.PH
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Gender | Female
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Dates
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Enumeration Date | 09/07/2008
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Last Update Date | 09/07/2008
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Provider Practice Location Address
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Address Line | 2516 CENTRAL AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-5313
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Country | US
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Telephone | 704-344-6494
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Fax | 704-344-6469
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Provider Business Mailing Address
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Address Line | PO BOX 36839
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City | CHARLOTTE
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State | NC
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Zip | 28236-6839
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Country | US
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Telephone | 704-576-4162
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Fax | 704-364-4574
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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 | 25452
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16299
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License Number State | NC
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