Provider Demographics
NPI:1255544060
Name:HENNIGAN, JR, JAMES THOMAS (RPH, PHARM D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:HENNIGAN, JR
Suffix:
Gender:M
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 GRANBERRY RD
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-5568
Mailing Address - Country:US
Mailing Address - Phone:337-463-2662
Mailing Address - Fax:
Practice Address - Street 1:1103 W 1ST ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3705
Practice Address - Country:US
Practice Address - Phone:337-463-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist