MEDICARE: MRS. SUSAN JANE HENDERSON RPH,MBA

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	037697	NY

General Provider Information

NPI Number	:	1942480595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN JANE HENDERSON RPH,MBA

Provider Business Mailing Address
First Line	:	27 SHADY OAKS CT
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-2419
Country	:	US
Telephone Number	:	716-636-0301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 S MAIN ST
Second Line	:	RITE AID #665
City	:	MEDINA
State	:	NY
Zip	:	14103-9779
Country	:	US
Telephone Number	:	585-798-1980
Fax Number	:	585-798-1387

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

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	02/24/2010

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