MEDICARE: MR. DOUGLAS JAY HENGER

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
1	183500000X	Pharmacist	5302041040	MI
2	183500000X	Pharmacist	RP035967L	PA

General Provider Information

NPI Number	:	1467903534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS JAY HENGER

Provider Business Mailing Address
First Line	:	30729 LYON CENTER DR E
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-8903
Country	:	US
Telephone Number	:	248-486-8941
Fax Number	:	844-287-2470

Provider Business Practice Location Address
First Line	:	30729 LYON CENTER DR E
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-8903
Country	:	US
Telephone Number	:	248-486-8941
Fax Number	:	844-287-2470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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