Provider Demographics
NPI:1457340309
Name:HENKE, BETH ANN (RPH)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:HENKE
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 1:6104 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-9516
Mailing Address - Country:US
Mailing Address - Phone:972-540-7789
Mailing Address - Fax:
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3465
Practice Address - Country:US
Practice Address - Phone:972-498-4740
Practice Address - Fax:972-498-7644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist