Provider Demographics
NPI:1154312924
Name:HENRY, MERYL B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MERYL
Middle Name:B
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3716 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5200
Mailing Address - Country:US
Mailing Address - Phone:678-358-5091
Mailing Address - Fax:770-720-5455
Practice Address - Street 1:201 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2408
Practice Address - Country:US
Practice Address - Phone:770-720-5272
Practice Address - Fax:770-720-5455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist