Provider Demographics
NPI:1851037881
Name:HENDERSON PHARMACY LLC
Entity Type:Organization
Organization Name:HENDERSON PHARMACY LLC
Other - Org Name:HENDERSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-650-8482
Mailing Address - Street 1:2410 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2735
Mailing Address - Country:US
Mailing Address - Phone:725-238-4608
Mailing Address - Fax:725-238-4610
Practice Address - Street 1:2410 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2735
Practice Address - Country:US
Practice Address - Phone:725-238-4608
Practice Address - Fax:725-238-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy