Kristopher Henderson, PHARM. D., B.S.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PH60603603 Issued in WA

Practice address

1501 Bay Ave
Ocean Park, WA 98640-4203

Phone

(360) 665-5181

NPI assigned

Sep 22, 2015

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science, Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peninsula Pharmacies Inc

  dba Ilwaco Pharmacy

  • Community/Retail Pharmacy
  • Ilwaco, WA
  • NPI 1255416038
  NPD (past)
• Peninsula Pharmacies Inc

  dba Long Beach Pharmacy

  • Community/Retail Pharmacy
  • Long Beach, WA
  • NPI 1275615106
  NPD (past)
• Sagen's Pharmacy Inc

  dba Raymond Pharmacy

  • Community/Retail Pharmacy
  • Raymond, WA
  • NPI 1508962531

  Pharmacist

  NPD (past)
• Sagen's Pharmacy Inc

  dba Raymond Pharmacy

  • Long Term Care Pharmacy
  • Raymond, WA
  • NPI 1760136493
  NPD (past)

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

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1730558685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BOLSTAD AVE",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "98631",
            "telephone_number": "360-642-3200",
            "fax_number": "360-642-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 BAY AVE",
            "city": "OCEAN PARK",
            "state": "WA",
            "postal_code": "986404203",
            "telephone_number": "360-665-5181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 W 6th St",
            "address_purpose": "LOCATION",
            "city": "The Dalles",
            "state": "OR",
            "postal_code": "970583515",
            "country_code": "US",
            "telephone_number": "541-965-1726",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 Commercial St",
            "address_purpose": "LOCATION",
            "city": "Raymond",
            "state": "WA",
            "postal_code": "985772509",
            "country_code": "US",
            "telephone_number": "360-942-2634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 BOLSTAD AVE",
            "address_purpose": "LOCATION",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "98631",
            "country_code": "US",
            "telephone_number": "360-642-3200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 1st Ave S",
            "address_purpose": "LOCATION",
            "city": "Ilwaco",
            "state": "WA",
            "postal_code": "986249100",
            "country_code": "US",
            "telephone_number": "360-642-3133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "PHARM. D., B.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-22",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "WA",
            "license": "PH60603603",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0014930",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Free by the Sea at Sunset View Freedom Center
• Thomas R Geha, L.AC., MAOM
• Melissa Gritz, LCSW
• Nikki Lee Hartley-Jonason, FNP
• Durinda Haukap, RD
• Deborah Hoenig
• Patrice Johnell, MSN, FNP-BC
• Nyna Rose Krause/Beadle
• Mihaela Lebo
• Jerome March, DNP, FNP-BC

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Ocean Park, WA
• Providers in Ocean Park, WA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.