Provider Demographics
NPI:1982657086
Name:HENRION, ROBERTA ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:ANN
Last Name:HENRION
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20135 N GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5022
Mailing Address - Country:US
Mailing Address - Phone:248-356-7972
Mailing Address - Fax:
Practice Address - Street 1:1701 BALDWIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3412
Practice Address - Country:US
Practice Address - Phone:248-253-0521
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023083183500000X
CO11636183500000X
CA31841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist