Provider Demographics
NPI:1689097776
Name:HENRY, PATRICK W (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:W
Last Name:HENRY
Suffix:
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 1:606 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2008
Mailing Address - Country:US
Mailing Address - Phone:206-324-9360
Mailing Address - Fax:206-834-4013
Practice Address - Street 1:611 12TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-1911
Practice Address - Country:US
Practice Address - Phone:206-324-9360
Practice Address - Fax:206-834-4013
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000407791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist