Provider Demographics
NPI:1821424987
Name:HENSON, JOEL ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ALLEN
Last Name:HENSON
Suffix:
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 1:25441 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9645
Mailing Address - Country:US
Mailing Address - Phone:541-517-4834
Mailing Address - Fax:541-935-8950
Practice Address - Street 1:24991 HIGHWAY 126
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-9459
Practice Address - Country:US
Practice Address - Phone:541-935-2201
Practice Address - Fax:541-935-8950
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist