Provider Demographics
NPI:1811296114
Name:HENIGIN, ROSANNE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:M
Last Name:HENIGIN
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 1:133 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1062
Mailing Address - Country:US
Mailing Address - Phone:724-459-7047
Mailing Address - Fax:
Practice Address - Street 1:200 RESORT PLAZA DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7964
Practice Address - Country:US
Practice Address - Phone:724-459-5938
Practice Address - Fax:724-459-5034
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028733L183500000X
FLPS36981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist