Provider Demographics
NPI:1790084564
Name:LAND, HENRY C JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:C
Last Name:LAND
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-1751
Mailing Address - Country:US
Mailing Address - Phone:717-530-9111
Mailing Address - Fax:717-530-8623
Practice Address - Street 1:300 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-1751
Practice Address - Country:US
Practice Address - Phone:717-530-9111
Practice Address - Fax:717-530-8623
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027058L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist