Provider Demographics
NPI:1295840221
Name:HENDERSON DRUGS LLC
Entity Type:Organization
Organization Name:HENDERSON DRUGS LLC
Other - Org Name:HENDERSON DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-736-5631
Mailing Address - Street 1:100 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2323
Mailing Address - Country:US
Mailing Address - Phone:317-736-5631
Mailing Address - Fax:317-346-6669
Practice Address - Street 1:100 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2323
Practice Address - Country:US
Practice Address - Phone:317-736-5631
Practice Address - Fax:317-346-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IN60005118A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200217790AMedicaid
2023715OtherPK
1202350001Medicare NSC