MEDICARE: HENDERSON SPECIALTY RX LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH04439	OTHER	NV	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1861119588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON SPECIALTY RX LLC

Provider Business Mailing Address
First Line	:	2865 SIENA HEIGHTS DR STE 111
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4168
Country	:	US
Telephone Number	:	702-476-9088
Fax Number	:	702-442-8123

Provider Business Practice Location Address
First Line	:	2865 SIENA HEIGHTS DR STE 111
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4168
Country	:	US
Telephone Number	:	702-476-9088
Fax Number	:	702-442-8123

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	IGOR CHERNYAVSKY
Credential	:
Telephone Number	:	702-476-9088

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	08/05/2024

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Directions to “HENDERSON SPECIALTY RX LLC ” Practice Location

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