Henderson's Drug Store, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

027457 Issued in NY

Legal business name

HENDERSON'S DRUG STORE, INC.

Doing business as

Park Pharmacy

Practice address

27 Shethar St
Hammondsport, NY 14840-9380

Phone

(607) 569-2800

Fax

(607) 569-3250

NPI assigned

Apr 25, 2006

Reactivated

May 22, 2012

Last updated

May 22, 2012By 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

Lawrence A Jepsen

Title

President

Phone

(607) 535-4999

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park Pharmacy Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Naples Pharmacy, Inc.

  • Pharmacy
  • Naples, NY
  • NPI 1811953201

  Member Of

  NPD member

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1568428993",
    "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": "27 SHETHAR ST",
            "city": "HAMMONDSPORT",
            "state": "NY",
            "postal_code": "148409380",
            "telephone_number": "607-569-2800",
            "fax_number": "607-569-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON'S DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2012-05-22",
        "deactivation_date": "2012-04-19",
        "reactivation_date": "2012-05-22",
        "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": "027457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02694791",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda Dickinson, RN
• Great Expectations Physical, Occupational, and Speech Therapy, PLLC
• Hammondsport Central Schools
• Hammondsport Volunteer Ambulance Corps, Inc.
• Amber Ann Haxton, LMSW
• Michelle Reney Lehman, COTA
• Patrick Lepkowski, D.P.T.
• Kristen Medrek, LPN
• Denise Menger, COTA
• MM Nurse Practitioner in Family Health Mobile Care (MM Mobile Care)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; 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.