Provider Demographics
NPI:1457625899
Name:HENDERSON, JAMES KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 S BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8020
Mailing Address - Country:US
Mailing Address - Phone:907-262-8737
Mailing Address - Fax:907-260-7405
Practice Address - Street 1:182 S BIRCH ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8020
Practice Address - Country:US
Practice Address - Phone:907-262-8737
Practice Address - Fax:907-260-7405
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist