MEDICARE: MR. ANTHONY J PENNELLA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00015062	WA

General Provider Information

NPI Number	:	1538432620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY J PENNELLA RPH

Provider Business Mailing Address
First Line	:	2811 W 10TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-3104
Country	:	US
Telephone Number	:	509-735-8733
Fax Number	:	509-735-8727

Provider Business Practice Location Address
First Line	:	2811 W 10TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-3104
Country	:	US
Telephone Number	:	509-735-8733
Fax Number	:	509-735-8727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	02/20/2012

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