MEDICARE: MR. STEVEN J PENNOCK RPH

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
1	183500000X	Pharmacist	23341	TX

General Provider Information

NPI Number	:	1548598360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN J PENNOCK RPH

Provider Business Mailing Address
First Line	:	1610 HIGHWAY 46 W
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4737
Country	:	US
Telephone Number	:	830-626-7142
Fax Number	:	830-626-7152

Provider Business Practice Location Address
First Line	:	1610 HIGHWAY 46 W
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4737
Country	:	US
Telephone Number	:	830-626-7142
Fax Number	:	830-626-7152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	12/07/2009

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