Provider Demographics
NPI:1700252160
Name:HENSLEY, JAYSON (RPH)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:HENSLEY
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 1:113 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6589
Mailing Address - Country:US
Mailing Address - Phone:817-773-2569
Mailing Address - Fax:
Practice Address - Street 1:225 E SPRING ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-3380
Practice Address - Country:US
Practice Address - Phone:817-594-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist