Provider Demographics
NPI:1477714681
Name:HENNING, WILL
Entity Type:Individual
Prefix:MR
First Name:WILL
Middle Name:
Last Name:HENNING
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 1:1520 BRUNDAGE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2949
Mailing Address - Country:US
Mailing Address - Phone:661-327-4265
Mailing Address - Fax:661-327-0534
Practice Address - Street 1:1520 BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2949
Practice Address - Country:US
Practice Address - Phone:661-327-4265
Practice Address - Fax:661-327-0534
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist