Healthcare Provider Details

I. General information

NPI: 1588582936
Provider Name (Legal Business Name): ELIZABETH PENNINGTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ALABAMA AVE S
BREMEN GA
30110-2002
US

IV. Provider business mailing address

84 BEECH TRL
DALLAS GA
30157-5024
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-3847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: