Provider Demographics
NPI:1114687266
Name:PENNY, JOHN CLETUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLETUS
Last Name:PENNY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41437 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1304
Mailing Address - Country:US
Mailing Address - Phone:661-733-4152
Mailing Address - Fax:
Practice Address - Street 1:866 W LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2342
Practice Address - Country:US
Practice Address - Phone:661-942-1461
Practice Address - Fax:661-942-8986
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist