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NPI Code Detail

MEDICARE: MICHAEL HENDERSON PHARMD

MEDICARE: MICHAEL HENDERSON PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist73786CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
173786OTHERCAPHARMACIST LICENSE (RPH)

General Provider Information

NPI Number : 1215301197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL HENDERSON PHARMD
Provider Business Mailing Address
First Line : 1745 DEL MAR RD
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95531-8319
Country : US
Telephone Number : 208-703-6061
Fax Number : 707-464-1627
Provider Business Practice Location Address
First Line : 900 E WASHINGTON BLVD
Second Line : ATTN PHARMACY
City : CRESCENT CITY
State : CA
Zip : 95531-8118
Country : US
Telephone Number : 707-464-1452
Fax Number : 707-464-1627
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2015
Last Update Date : 11/16/2015

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