Provider Demographics
NPI:1144824087
Name:HENDERSON, DANIEL PATRICK (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2262
Mailing Address - Country:US
Mailing Address - Phone:617-269-7656
Mailing Address - Fax:617-269-8331
Practice Address - Street 1:423 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2262
Practice Address - Country:US
Practice Address - Phone:617-269-7656
Practice Address - Fax:617-269-8331
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist