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General NPI Number Information
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NPI Number | 1538426093
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Entity Type | Organization
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Legal Business Name | PENNOCK PHARMACY
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 12851 W M 179 HWY
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City | WAYLAND
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State | MI
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Zip | 49348-9318
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Country | US
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Telephone | 269-945-8050
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Fax | 269-945-8048
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Provider Business Mailing Address
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Address Line | 12851 W M 179 HWY
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City | WAYLAND
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State | MI
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Zip | 49348-9318
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Country | US
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Telephone | 269-945-8050
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Fax | 269-945-8048
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Authorized Official
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Title or Position | CERTIFIED PHARMACY TECHNICIAN
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Name | AMANDA RISNER
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Credential | R. PH
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Telephone | 269-945-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009800
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License Number State | MI
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