# HENDERSON'S DRUG STORE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Montour Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184681868
- **Authorized official:** LAWRENCE A JEPSEN (PRESIDENT)
- **Authorized official phone:** (607) 535-4999

## Contact information

- **Practice address:** 320 W MAIN STREET, MONTOUR FALLS, NY 14865
- **Practice address phone:** (607) 535-7272
- **Practice address fax:** (607) 535-4079
- **Mailing address:** PO BOX 696, WATKINS GLEN, NY 14891-0696
- **Mailing address phone:** (607) 535-4999
- **Mailing address fax:** (607) 535-4320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 025563 | NY | Yes |

## Other

- **Enumeration date:** 04/27/2006
- **Last updated:** 03/04/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02363844 | — | NY |