Provider Demographics
NPI:1396832101
Name:HENDERSON DRUGS, INC
Entity Type:Organization
Organization Name:HENDERSON DRUGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLDEVILA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-624-6591
Mailing Address - Street 1:2021 HOSPITAL DR
Mailing Address - Street 2:P O BOX 819
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7205
Mailing Address - Country:US
Mailing Address - Phone:662-624-6591
Mailing Address - Fax:662-627-3389
Practice Address - Street 1:2021 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7205
Practice Address - Country:US
Practice Address - Phone:662-624-6591
Practice Address - Fax:662-627-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00045069Medicaid
MS2501321OtherNCPDP
MS00032336Medicaid
0253350001Medicare NSC