Provider Demographics
NPI:1073028825
Name:HENSON, JONATHAN TYLER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TYLER
Last Name:HENSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6686
Mailing Address - Country:US
Mailing Address - Phone:405-324-8170
Mailing Address - Fax:405-324-8178
Practice Address - Street 1:201 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6686
Practice Address - Country:US
Practice Address - Phone:405-324-8170
Practice Address - Fax:405-324-8178
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist