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NPI Code Detail

MEDICARE: RANDY WILLIAM PENNINGTON P.D.

MEDICARE: RANDY WILLIAM PENNINGTON P.D.
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
1183500000XPharmacist6054TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11467401315OTHERTNNPI

General Provider Information

NPI Number : 1568784262
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDY WILLIAM PENNINGTON P.D.
Provider Business Mailing Address
First Line : 1897 GENERAL GEORGE PATTON DR
Second Line : SUITE 112
City : FRANKLIN
State : TN
Zip : 37067-7250
Country : US
Telephone Number : 615-791-8679
Fax Number : 615-791-7666
Provider Business Practice Location Address
First Line : 1897 GENERAL GEORGE PATTON DR
Second Line : SUITE 112
City : FRANKLIN
State : TN
Zip : 37067-7250
Country : US
Telephone Number : 615-791-8679
Fax Number : 615-791-7666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2010
Last Update Date : 02/22/2010

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