Provider Demographics
NPI:1679183453
Name:HENDERSON, JAMES HILL III (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HILL
Last Name:HENDERSON
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7873
Mailing Address - Country:US
Mailing Address - Phone:850-622-3772
Mailing Address - Fax:
Practice Address - Street 1:725 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7873
Practice Address - Country:US
Practice Address - Phone:850-622-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist