Individual
MR. JERE DAVID HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1381 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-1790
(541) 672-5738
(541) 672-8520
Mailing address
1381 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-1790
(541) 672-5738
(541) 672-8520
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6429
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6429
STATE PHARMACIST LICENSE
OR
Enumeration date
02/11/2012
Last updated
02/11/2012
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