Provider Demographics
NPI:1326089863
Name:HENDERSON, RONALD W (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:W
Last Name:HENDERSON
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 1:124 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9426
Mailing Address - Country:US
Mailing Address - Phone:740-373-8132
Mailing Address - Fax:740-423-8301
Practice Address - Street 1:1008 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2390
Practice Address - Country:US
Practice Address - Phone:740-423-7271
Practice Address - Fax:740-423-8301
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-12497183500000X
WV3396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist