Provider Demographics
NPI:1174959159
Name:HENSLEY, ANDREA RENAE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENAE
Last Name:HENSLEY
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 1:415 ROCK HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1535
Mailing Address - Country:US
Mailing Address - Phone:304-588-0036
Mailing Address - Fax:
Practice Address - Street 1:4205 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2501
Practice Address - Country:US
Practice Address - Phone:304-925-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22910183500000X
WVRP0007938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist