Provider Demographics
NPI:1467903534
Name:HENGER, DOUGLAS JAY
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JAY
Last Name:HENGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30729 LYON CENTER DR E
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-8903
Mailing Address - Country:US
Mailing Address - Phone:248-486-8941
Mailing Address - Fax:844-287-2470
Practice Address - Street 1:30729 LYON CENTER DR E
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-8903
Practice Address - Country:US
Practice Address - Phone:248-486-8941
Practice Address - Fax:844-287-2470
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041040183500000X
PARP035967L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist