Provider Demographics
NPI:1417084146
Name:HENEGAR, MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HENEGAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 HOFF LANE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4562
Mailing Address - Country:US
Mailing Address - Phone:865-932-7775
Mailing Address - Fax:865-932-7770
Practice Address - Street 1:1050 RUTLEDGE PIKE
Practice Address - Street 2:OKIES PHARMACY
Practice Address - City:BLAINE
Practice Address - State:TN
Practice Address - Zip Code:37709-3027
Practice Address - Country:US
Practice Address - Phone:865-932-7775
Practice Address - Fax:865-932-7770
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN-10815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist