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General NPI Number Information
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NPI Number | 1902111529
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Entity Type | Individual
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Provider Name | STEPHEN HENDERSON RPH
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Gender | Male
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 1010 LAY DAM RD
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City | CLANTON
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State | AL
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Zip | 35045-2306
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Country | US
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Telephone | 205-280-3529
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 BLIND BROOK LN
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City | VESTAVIA
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State | AL
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Zip | 35216-3304
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Country | US
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Telephone | 205-979-8811
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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 | 9797
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License Number State | AL
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