Provider Demographics
NPI:1972871002
Name:HENLEY, ALAN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:M
Last Name:HENLEY
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 1:625 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3459
Mailing Address - Country:US
Mailing Address - Phone:719-473-8834
Mailing Address - Fax:719-473-0445
Practice Address - Street 1:625 N 19TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3459
Practice Address - Country:US
Practice Address - Phone:719-473-8834
Practice Address - Fax:719-473-0445
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist