Provider Demographics
NPI:1861220287
Name:HENDERSON PHARMACY LLC
Entity type:Organization
Organization Name:HENDERSON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-723-4475
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-0711
Mailing Address - Country:US
Mailing Address - Phone:402-723-4475
Mailing Address - Fax:402-723-4476
Practice Address - Street 1:1060 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-9798
Practice Address - Country:US
Practice Address - Phone:402-723-4475
Practice Address - Fax:402-723-4476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDERSON PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy