Provider Demographics
NPI:1477834935
Name:HENDERSON, SUSAN BETH (BS PHARMACY RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BS PHARMACY RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15844 COTTERS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1582
Mailing Address - Country:US
Mailing Address - Phone:616-847-2928
Mailing Address - Fax:
Practice Address - Street 1:1991 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4246
Practice Address - Country:US
Practice Address - Phone:231-773-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist