Provider Demographics
NPI:1063015428
Name:CALAIS, PENNY
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:CALAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 S DAIRY ASHFORD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2307
Mailing Address - Country:US
Mailing Address - Phone:281-493-3260
Mailing Address - Fax:281-496-1083
Practice Address - Street 1:1339 S DAIRY ASHFORD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2307
Practice Address - Country:US
Practice Address - Phone:281-493-3260
Practice Address - Fax:281-496-1083
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist