Provider Demographics
NPI:1740904499
Name:HENIN, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HENIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16279 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5421
Mailing Address - Country:US
Mailing Address - Phone:562-630-1620
Mailing Address - Fax:562-630-1720
Practice Address - Street 1:16279 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5421
Practice Address - Country:US
Practice Address - Phone:562-630-1620
Practice Address - Fax:562-630-1720
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist