Ray Henicke
Individual provider Active NPI Pharmacist · Albany, TX
NPI 1578037586 · NPPES record last updated Jan 14, 2019
Key facts
- NPI
- 1578037586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 21348 (UT)
- Practice address
- 104 S. Main Street
Albany, TX 76430 - Phone
- (325) 668-0879
- NPI assigned
- Jan 14, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21348 | UT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 21348 | UT | Yes |
Addresses
Primary practice location
104 S. Main Street
Albany, TX 76430
Mailing address
2626 Button Willow Pkwy
Abilene, TX 79606-3514
Phone (325) 668-0879
Other providers in Albany, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.