Provider Demographics
NPI:1376093948
Name:HENSON, LORI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:HENSON
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 1:7282 SOUTHERN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-1836
Mailing Address - Country:US
Mailing Address - Phone:828-230-1401
Mailing Address - Fax:
Practice Address - Street 1:7282 SOUTHERN VIEW RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-1836
Practice Address - Country:US
Practice Address - Phone:828-230-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220506183500000X
NC15546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist