Provider Demographics
NPI:1578837035
Name:HENLEY, BYRON BOYD JR (DR)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:BOYD
Last Name:HENLEY
Suffix:JR
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:AR
Mailing Address - Zip Code:72512
Mailing Address - Country:US
Mailing Address - Phone:870-670-5098
Mailing Address - Fax:870-670-5905
Practice Address - Street 1:404 MARKET STREET
Practice Address - Street 2:
Practice Address - City:HORSESHOE BEND
Practice Address - State:AR
Practice Address - Zip Code:72512
Practice Address - Country:US
Practice Address - Phone:870-670-5098
Practice Address - Fax:870-670-5905
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist