Provider Demographics
NPI:1316222714
Name:HENNING, JANIS (RPH)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:HENNING
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 1:4011 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3034
Mailing Address - Country:US
Mailing Address - Phone:563-359-3438
Mailing Address - Fax:563-359-3762
Practice Address - Street 1:4011 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3034
Practice Address - Country:US
Practice Address - Phone:563-359-3438
Practice Address - Fax:563-359-3762
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist