Organization
HENDERSON'S DRUG STORE, INC.
Active
Other names
Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE A JEPSEN (PRESIDENT)
(607) 535-4999
Entity
Organization
Contact information
Practice address
27 SHETHAR ST, HAMMONDSPORT, NY 14840-9380
(607) 569-2800
(607) 569-3250
Mailing address
PO BOX 696, WATKINS GLEN, NY 14891-0696
(607) 535-4999
(607) 535-4320
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
027457
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02694791
—
NY
Enumeration date
04/25/2006
Last updated
05/22/2012
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