Henderson Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

HENDERSON PHARMACY LLC

Doing business as

Henderson Pharmacy

Practice address

1060 N Main St
Henderson, NE 68371-9798

Phone

(402) 723-4475

Fax

(402) 723-4476

NPI assigned

Jan 6, 2022

Last updated

Oct 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randy Glen Baldwin, PHARMDNPI 1346901949

Title

Pic

Phone

(402) 723-4475

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Henderson Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Tax ID family

Henderson Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Henderson Pharmacy LLC

  dba Henderson Pharmacy LTC

  • Long Term Care Pharmacy
  • Henderson, NE
  • NPI 1861220287
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Henderson Pharmacy LLC

  dba Henderson Pharmacy LTC

  • Long Term Care Pharmacy
  • Henderson, NE
  • NPI 1861220287
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randy Glen Baldwin, PHARMD

  • Pharmacist
  • Henderson, NE
  • NPI 1346901949
  NPD Authorized official

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1407517972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 711",
            "city": "HENDERSON",
            "state": "NE",
            "postal_code": "683710711",
            "telephone_number": "402-723-4475",
            "fax_number": "402-723-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 N MAIN ST",
            "city": "HENDERSON",
            "state": "NE",
            "postal_code": "683719798",
            "telephone_number": "402-723-4475",
            "fax_number": "402-723-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "BALDWIN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "402-723-4475",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026916700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henderson Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heartland Community Schools
• Henderson Health Care Services, Inc. (Henderson Community Hospital)
• Henderson Health Care Services, Inc. (Henderson Care Center)
• Henderson Health Care Services, Inc. (Henderson Family Care)
• Henderson Health Care Services, Inc. (Rosewood Court)
• Henderson Pharmacy LLC (Henderson Pharmacy LTC)
• Pamela E Homolka
• Kretz Chiropractic LLC
• Megan Kroeker
• Sandra Lee Kroeker, LCSW

• Community/Retail Pharmacy in Henderson, NE
• Providers in Henderson, NE by specialty
• Community/Retail Pharmacy in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.