Individual
THAIANE PORTO HENSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH, MBA
Contact information
Practice address
401 BICENTENNIAL WAY, SANTA ROSA, CA 95403-2149
(707) 393-3606
Mailing address
401 BICENTENNIAL WAY, SANTA ROSA, CA 95403-2149
(707) 393-3606
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
121181
MN
1835P2201X
Ambulatory Care Pharmacist
Primary
65159
CA
Other
Enumeration date
10/04/2015
Last updated
10/04/2015
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