Basic Information
| Provider Information | |||||||||
| NPI: | 1750502951 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENNING | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3063 HERRING ROAD | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496139604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313528146 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1105 SIXTH STREET | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319355000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302022265 | MI | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 26013465A | IN | N | Pharmacy Service Providers | Pharmacist |
No ID Information.