Provider Demographics
NPI:1871198499
Name:HENLEY, ANGELLE MARIE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:ANGELLE
Middle Name:MARIE
Last Name:HENLEY
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10607 ACACIA FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5940
Mailing Address - Country:US
Mailing Address - Phone:281-619-6581
Mailing Address - Fax:
Practice Address - Street 1:6011 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-3103
Practice Address - Country:US
Practice Address - Phone:713-522-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist