Provider Demographics
NPI:1821303496
Name:PENNYMAN, DILQUELLE D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DILQUELLE
Middle Name:D
Last Name:PENNYMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DILQUELLE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17103 VAN AKEN BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3643
Mailing Address - Country:US
Mailing Address - Phone:216-308-1405
Mailing Address - Fax:
Practice Address - Street 1:2040 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-2557
Practice Address - Country:US
Practice Address - Phone:216-258-0248
Practice Address - Fax:833-623-2901
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032306131835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist