Provider Demographics
NPI:1306282884
Name:CHEATLE, PENNI ANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:PENNI
Middle Name:ANNE
Last Name:CHEATLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-9138
Mailing Address - Country:US
Mailing Address - Phone:860-585-5478
Mailing Address - Fax:
Practice Address - Street 1:160 INDIANA ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-9138
Practice Address - Country:US
Practice Address - Phone:860-585-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist