Provider Demographics
NPI:1679874911
Name:HENRY, STEPHANIE PROCISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PROCISE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KINGSCOTE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4674
Mailing Address - Country:US
Mailing Address - Phone:804-307-7833
Mailing Address - Fax:
Practice Address - Street 1:189 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2107
Practice Address - Country:US
Practice Address - Phone:540-428-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist