MEDICARE: MS. HOLLY LANE HENSCHEL 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
1	183500000X	Pharmacist	24226	IA

General Provider Information

NPI Number	:	1740950682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY LANE HENSCHEL PHARMD

Provider Business Mailing Address
First Line	:	5050 EDGEWOOD RD NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52411-6613
Country	:	US
Telephone Number	:	319-294-9193
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 EDGEWOOD RD NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52411-6613
Country	:	US
Telephone Number	:	319-294-9193
Fax Number	:

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

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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