Provider Demographics
NPI:1225303555
Name:HENRY, CASSIE DEVEAUX (RPH)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:DEVEAUX
Last Name:HENRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 FURMAN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7025
Mailing Address - Country:US
Mailing Address - Phone:843-766-1757
Mailing Address - Fax:
Practice Address - Street 1:2396 FURMAN DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7025
Practice Address - Country:US
Practice Address - Phone:843-766-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist