Provider Demographics
NPI:1740521228
Name:HENDERSON, DEBRA LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:RANGEL
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78364-1133
Mailing Address - Country:US
Mailing Address - Phone:210-827-4005
Mailing Address - Fax:361-595-1449
Practice Address - Street 1:409 E KLEBERG AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-3804
Practice Address - Country:US
Practice Address - Phone:361-595-1441
Practice Address - Fax:361-595-1449
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist