Provider Demographics
NPI:1689964033
Name:HENKEL, PEGGY DIMETRA
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:DIMETRA
Last Name:HENKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:DIMETRA
Other - Last Name:HENKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:40-42 WEST MARKET STREET
Mailing Address - Street 2:40 WEST MARKET STREET
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401
Mailing Address - Country:US
Mailing Address - Phone:717-854-4432
Mailing Address - Fax:717-854-4412
Practice Address - Street 1:40 W MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1228
Practice Address - Country:US
Practice Address - Phone:717-854-4432
Practice Address - Fax:717-854-5412
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034404T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist