Provider Demographics
NPI:1184016156
Name:HENEN, ATIF H (RPH)
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:H
Last Name:HENEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640970
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0970
Mailing Address - Country:US
Mailing Address - Phone:407-259-1574
Mailing Address - Fax:352-746-7336
Practice Address - Street 1:3565 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3503
Practice Address - Country:US
Practice Address - Phone:352-746-0096
Practice Address - Fax:352-746-7336
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist