Provider Demographics
NPI:1871944082
Name:HENDERSON, JUSTIN WILLIAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 MEADE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1304
Mailing Address - Country:US
Mailing Address - Phone:734-355-5689
Mailing Address - Fax:
Practice Address - Street 1:2509 MEADE CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1304
Practice Address - Country:US
Practice Address - Phone:734-355-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist