NPIMap

Organization Active NPI

Henderson Drugs, Inc

  • Pharmacist
  • Clarksdale, MS
National Provider Identifier
1396832101
Registry record updated Sep 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
00412 Issued in MS
Legal business name
HENDERSON DRUGS, INC
Practice address
2021 Hospital Dr
Clarksdale, MS 38614-7205
Phone
(662) 624-6591
Fax
(662) 627-3389
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2016

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

Authorized official

Name
Val Soldevila, RPHNPI 1922195643
Title
Pres
Phone
(662) 624-6591

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 00412 MS Primary

Addresses

Primary practice location

2021 Hospital Dr
Clarksdale, MS 38614-7205

Mailing address

2021 Hospital Dr
P O Box 819
Clarksdale, MS 38614-7205
Phone (662) 624-6591

Other identifiers 3

IdentifierTypeStateIssuer
00045069MedicaidMS
2501321OtherMSNCPDP
00032336MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930088362 MS DME Supplier - PharmacyDME Supplier - Medical Supply CompanyDME Supplier - Orthotic PersonnelDME Supplier - Oxygen & Equipment 6002933157 Practice locations: Clarksdale, MS
O20151029000464 MS Part B Supplier - Mass Immunization (Roster Biller Only) 6002933157 Practice locations: Clarksdale, MS
O20240521002571 MS Part B Supplier - Independent Clinical Laboratory 6002933157 Practice locations: Clarksdale, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Henderson'S Economy Drug2021 Hospital Dr, Clarksdale, MS 38614-7205(662) 624-6591 Nebulizer Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Patient Lifts|Power… Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

270 Delta Ave
Clarksdale, MS 38614
Phone (662) 624-6591

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1396832101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 HOSPITAL DR",
            "address_2": "P O BOX 819",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147205",
            "telephone_number": "662-624-6591",
            "fax_number": "662-627-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 HOSPITAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147205",
            "telephone_number": "662-624-6591",
            "fax_number": "662-627-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON DRUGS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2016-09-30",
        "status": "A",
        "authorized_official_last_name": "SOLDEVILA",
        "authorized_official_first_name": "VAL",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "662-624-6591",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "00412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00045069",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2501321",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00032336",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.