Healthcare Provider Details

I. General information

NPI: 1063846798
Provider Name (Legal Business Name): ANTHONY J PENERA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 BURNET RD
AUSTIN TX
78756-3316
US

IV. Provider business mailing address

12005 ROTHERHAM DR
AUSTIN TX
78753-6843
US

V. Phone/Fax

Practice location:
  • Phone: 512-706-1900
  • Fax:
Mailing address:
  • Phone: 503-893-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number56273
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0013563
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: