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General NPI Number Information
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NPI Number | 1356090740
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Entity Type | Individual
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Provider Name | JESSICA PENNEY
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Gender | Female
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-762-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 RAINIER AVE S UNIT 361
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City | SEATTLE
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State | WA
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Zip | 98118-2155
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Country | US
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Telephone | 208-449-3560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P10230
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH61304086
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License Number State | WA
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