Provider Demographics
NPI:1407408214
Name:HENNEKE, JUDI
Entity Type:Individual
Prefix:MRS
First Name:JUDI
Middle Name:
Last Name:HENNEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 YOUENS DR
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962-3680
Mailing Address - Country:US
Mailing Address - Phone:979-725-6713
Mailing Address - Fax:979-725-6655
Practice Address - Street 1:406 YOUENS DR
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962-3680
Practice Address - Country:US
Practice Address - Phone:979-725-6713
Practice Address - Fax:979-725-6655
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31342333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy