Provider Demographics
NPI:1750502951
Name:HENNING, ANN S (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:S
Last Name:HENNING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 HERRING ROAD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:MI
Mailing Address - Zip Code:49613-9604
Mailing Address - Country:US
Mailing Address - Phone:231-352-8146
Mailing Address - Fax:
Practice Address - Street 1:1105 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022265183500000X
IN26013465A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist