Provider Demographics
NPI:1316180086
Name:HENDERSON, DONALD LAWRENCE
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LAWRENCE
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5108
Mailing Address - Country:US
Mailing Address - Phone:410-877-0611
Mailing Address - Fax:410-877-0611
Practice Address - Street 1:1327 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5108
Practice Address - Country:US
Practice Address - Phone:410-877-0611
Practice Address - Fax:410-877-0611
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11615183500000X
PARP035084L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist