Provider Demographics
NPI:1487202024
Name:HENLEY, CLARENCE EDWARD III (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:EDWARD
Last Name:HENLEY
Suffix:III
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 1:20116 OLD HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-9534
Mailing Address - Country:US
Mailing Address - Phone:662-436-7181
Mailing Address - Fax:
Practice Address - Street 1:834 BARNES CROSSING RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0909
Practice Address - Country:US
Practice Address - Phone:662-840-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-16068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist