Provider Demographics
NPI:1912423815
Name:HENDERSON PHARMACY SERVICES, INC.
Entity Type:Organization
Organization Name:HENDERSON PHARMACY SERVICES, INC.
Other - Org Name:HENDERSON PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-702-1181
Mailing Address - Street 1:186 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3106
Mailing Address - Country:US
Mailing Address - Phone:740-702-1181
Mailing Address - Fax:740-702-1190
Practice Address - Street 1:186 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3106
Practice Address - Country:US
Practice Address - Phone:740-702-1181
Practice Address - Fax:740-702-1190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDERSON PHARMACY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0204505003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0619183Medicaid