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NPI Code Detail

MEDICARE: TANISHIA HENDERSON

MEDICARE: TANISHIA HENDERSON
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
1183500000XPharmacistPS40615FL

General Provider Information

NPI Number : 1932485885
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANISHIA HENDERSON
Provider Business Mailing Address
First Line : 1587 N COURTENAY PKWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-4454
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1587 N COURTENAY PKWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-4454
Country : US
Telephone Number : 321-459-1647
Fax Number : 321-459-1201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2011
Last Update Date : 10/24/2011

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Directions to “ TANISHIA HENDERSON ” Practice Location

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