Provider Demographics
NPI:1144333865
Name:HENDERSON, DEBBIE B (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:B
Last Name:HENDERSON
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 1:20 GREENWOOD PLACE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-443-7200
Mailing Address - Fax:270-443-8537
Practice Address - Street 1:2700 HC MATHIS DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-3704
Practice Address - Country:US
Practice Address - Phone:270-443-7200
Practice Address - Fax:270-443-8537
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008105OtherSTATE LICENSE#