Healthcare Provider Details

I. General information

NPI: 1306510581
Provider Name (Legal Business Name): DEVIN PENNINGTON PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

15303 PROVIDENCE PIKE
BROOKVILLE OH
45309-8794
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-4331
  • Fax:
Mailing address:
  • Phone: 937-623-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03440864
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: