MEDICARE: DR. DILQUELLE D PENNYMAN PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03230613	OH
2	183500000X	Pharmacist	03230613	OH

General Provider Information

NPI Number	:	1821303496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DILQUELLE D PENNYMAN PHARMD

Provider Business Mailing Address
First Line	:	17103 VAN AKEN BLVD APT 204
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3643
Country	:	US
Telephone Number	:	216-308-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 LEE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-2557
Country	:	US
Telephone Number	:	216-258-0248
Fax Number	:	833-623-2901

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

Provider Enumeration Date	:	08/08/2010
Last Update Date	:	09/20/2024

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