Provider Demographics
NPI:1790524296
Name:HENRIETTA PHARMACY, INC.
Entity type:Organization
Organization Name:HENRIETTA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:940-538-4361
Mailing Address - Street 1:124 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365
Mailing Address - Country:US
Mailing Address - Phone:940-538-4361
Mailing Address - Fax:940-538-6345
Practice Address - Street 1:124 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365
Practice Address - Country:US
Practice Address - Phone:940-538-4361
Practice Address - Fax:940-538-6345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRIETTA PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy