Basic Information
| Provider Information | |||||||||
| NPI: | 1336100577 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENCH ENTERPRISES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RAYS PHARMACY AND WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 W HIGH ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435125302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197820950 | ||||||||
| FaxNumber: | 4197826047 | ||||||||
| Practice Location | |||||||||
| Address1: | 927 N CABLE RD | ||||||||
| Address2: | STE A | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458051747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192220778 | ||||||||
| FaxNumber: | 4192244692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | STAFFORD | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SSECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4197820950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | 021228900 | OH | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 3657852 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER | 2206044 | 05 | OH | MEDICAID |