MEDICARE: SIDNEY WINTERS HENDRY

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	024586	LA

General Provider Information

NPI Number	:	1487379970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY WINTERS HENDRY

Provider Business Mailing Address
First Line	:	307 SUSAN DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-1219
Country	:	US
Telephone Number	:	318-557-0126
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 DESIARD ST STE 300
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7363
Country	:	US
Telephone Number	:	318-998-3907
Fax Number	:	318-812-6020

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Directions to “ SIDNEY WINTERS HENDRY ” Practice Location

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