Provider Demographics
NPI:1720361983
Name:HENNING, NEIL
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:HENNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 MARSEILLE CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6067
Mailing Address - Country:US
Mailing Address - Phone:913-708-4350
Mailing Address - Fax:
Practice Address - Street 1:4109 MARSEILLE CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6067
Practice Address - Country:US
Practice Address - Phone:913-708-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist