Provider Demographics
NPI:1386037968
Name:HENNE, KAYLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:HENNE
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 1:240 SHADOWLINE DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5088
Mailing Address - Country:US
Mailing Address - Phone:828-264-4751
Mailing Address - Fax:
Practice Address - Street 1:240 SHADOWLINE DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5088
Practice Address - Country:US
Practice Address - Phone:828-264-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist