Provider Demographics
NPI:1205158615
Name:HENDERSON, MICHAEL S (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HENDERSON
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 1:3021 LONGBROOKE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1727
Mailing Address - Country:US
Mailing Address - Phone:727-546-5756
Mailing Address - Fax:727-544-3918
Practice Address - Street 1:4501 66TH ST N
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-4923
Practice Address - Country:US
Practice Address - Phone:727-546-5756
Practice Address - Fax:727-544-3918
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist