Provider Demographics
NPI:1518308543
Name:HENDERSON, RONAND EUGENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONAND
Middle Name:EUGENE
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 1:199 E LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-6019
Mailing Address - Country:US
Mailing Address - Phone:706-335-3569
Mailing Address - Fax:
Practice Address - Street 1:199 E LOUISE ST
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-6019
Practice Address - Country:US
Practice Address - Phone:706-754-3933
Practice Address - Fax:706-754-3974
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist