Provider Demographics
NPI:1952913303
Name:HENDERSON, SHARRON RENISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHARRON
Middle Name:RENISE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 BROADMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4750 E 450 S
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-8404
Practice Address - Country:US
Practice Address - Phone:888-282-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025049A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26025049AOtherLICENSE
IN26025049AOtherINDIANA PHARMACY BOARD