Provider Demographics
NPI:1942480595
Name:HENDERSON, SUSAN JANE (RPH,MBA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RPH,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SHADY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2419
Mailing Address - Country:US
Mailing Address - Phone:716-636-0301
Mailing Address - Fax:
Practice Address - Street 1:1422 S MAIN ST
Practice Address - Street 2:RITE AID #665
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9779
Practice Address - Country:US
Practice Address - Phone:585-798-1980
Practice Address - Fax:585-798-1387
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist