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General NPI Number Information
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NPI Number | 1942480595
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Entity Type | Individual
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Provider Name | SUSAN JANE HENDERSON RPH,MBA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 1422 S MAIN ST RITE AID #665
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City | MEDINA
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State | NY
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Zip | 14103-9779
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Country | US
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Telephone | 585-798-1980
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Fax | 585-798-1387
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Provider Business Mailing Address
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Address Line | 27 SHADY OAKS CT
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City | EAST AMHERST
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State | NY
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Zip | 14051-2419
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Country | US
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Telephone | 716-636-0301
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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 | 037697
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License Number State | NY
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