Provider Demographics
NPI:1760867873
Name:HENSLEY, JOHN WILLIS
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIS
Last Name:HENSLEY
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 1:1224 N NORWOOD ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-1334
Mailing Address - Country:US
Mailing Address - Phone:910-285-5787
Mailing Address - Fax:
Practice Address - Street 1:1224 N NORWOOD ST
Practice Address - Street 2:SUITE 12
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1334
Practice Address - Country:US
Practice Address - Phone:910-285-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist