Provider Demographics
NPI:1730558685
Name:HENDERSON, KRISTOPHER (PHARM D, BS)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PHARM D, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BOLSTAD AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631
Mailing Address - Country:US
Mailing Address - Phone:360-642-3200
Mailing Address - Fax:360-642-8786
Practice Address - Street 1:1501 BAY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN PARK
Practice Address - State:WA
Practice Address - Zip Code:98640-4203
Practice Address - Country:US
Practice Address - Phone:360-665-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH606036031835P0018X
ORRPH-0014930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist