Provider Demographics
NPI:1215574835
Name:PENNOYER, JESSECA LAUREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSECA
Middle Name:LAUREN
Last Name:PENNOYER
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 1:871 LYNDON ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1977
Mailing Address - Country:US
Mailing Address - Phone:858-922-2817
Mailing Address - Fax:
Practice Address - Street 1:160 COUNTRY CLUB GATE CTR
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5022
Practice Address - Country:US
Practice Address - Phone:831-373-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81427183500000X
AZS024269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist