Provider Demographics
NPI:1386714244
Name:LILES, PENNY SUE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:SUE
Last Name:LILES
Suffix:
Gender:F
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:HC 73 BOX 1002
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-9408
Mailing Address - Country:US
Mailing Address - Phone:606-796-0009
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 1 BOX 1005
Practice Address - Street 2:
Practice Address - City:TOLLESBORO
Practice Address - State:KY
Practice Address - Zip Code:41189
Practice Address - Country:US
Practice Address - Phone:606-798-2072
Practice Address - Fax:606-798-2222
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0118271835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy