Henderson'S Drug Store, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

027165 Issued in NY

Legal business name

HENDERSON'S DRUG STORE, INC.

Doing business as

Lyncourt Drug

Practice address

106 Arterial Rd
Syracuse, NY 13206-1558

Phone

(315) 437-0699

Fax

(315) 433-9091

NPI assigned

Apr 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lawrence A. Jepsen

Title

President

Phone

(607) 535-4999

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lyncourt Drug Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1245296672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 696",
            "city": "WATKINS GLEN",
            "state": "NY",
            "postal_code": "148910696",
            "telephone_number": "607-535-4999",
            "fax_number": "607-535-4320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 ARTERIAL RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132061558",
            "telephone_number": "315-437-0699",
            "fax_number": "315-433-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON'S DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "JEPSEN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "607-535-4999"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "027165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02639352",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lyncourt Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Hemmerlein, LMSW
• Anna Hendershot
• Sherri Camille Henderson-Mitchell, LPN
• Geoffrey Henderson
• Haley Henderson
• Maria Hendix
• Mark Galen Hendrick, RPH
• Jennifer D Hendricks, P.T.
• Nancy Hendrickson, LMSW
• Cassandra Gray Aster Hennelly, MD

• Pharmacy in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.