Provider Demographics
NPI:1962828939
Name:PENETAR, CRISTINA (RPH)
Entity type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:PENETAR
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 1:2968 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2600
Mailing Address - Country:US
Mailing Address - Phone:570-888-7516
Mailing Address - Fax:
Practice Address - Street 1:2968 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2600
Practice Address - Country:US
Practice Address - Phone:570-888-7516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448309183500000X
VA0202212630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP448309OtherPENNSYLVANIA BOARD OF PHARMACY
VA0202212630OtherVIRGINIA BOARD OF PHARMACY