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NPI Code Detail

MEDICARE: STEVEN CHRISTOPHER PENN

MEDICARE: STEVEN CHRISTOPHER PENN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist11417-40WI

General Provider Information

NPI Number : 1538436217
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN CHRISTOPHER PENN
Provider Business Mailing Address
First Line : 2985 S CHICAGO AVE
Second Line :
City : SOUTH MILWAUKEE
State : WI
Zip : 53172-3133
Country : US
Telephone Number : 414-762-9653
Fax Number :
Provider Business Practice Location Address
First Line : 2985 S CHICAGO AVE
Second Line :
City : SOUTH MILWAUKEE
State : WI
Zip : 53172-3133
Country : US
Telephone Number : 414-762-9653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2011
Last Update Date : 11/22/2011

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