Provider Demographics
NPI:1346671625
Name:HENRY, JAYMIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAYMIE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2897
Mailing Address - Country:US
Mailing Address - Phone:985-851-3284
Mailing Address - Fax:985-851-7593
Practice Address - Street 1:1633 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2897
Practice Address - Country:US
Practice Address - Phone:985-851-3284
Practice Address - Fax:985-851-7593
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.017710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist