Provider Demographics
NPI:1689824989
Name:HENRY, ANN D
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:D
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0346
Mailing Address - Country:US
Mailing Address - Phone:931-363-1640
Mailing Address - Fax:931-424-3284
Practice Address - Street 1:125 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3214
Practice Address - Country:US
Practice Address - Phone:931-363-1640
Practice Address - Fax:931-424-3284
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44741835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3545832Medicaid
TN014990001Medicare PIN