Provider Demographics
NPI:1245404888
Name:PENNY, TARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:PENNY
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 1:804 E HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2254
Mailing Address - Country:US
Mailing Address - Phone:254-547-9755
Mailing Address - Fax:254-547-9858
Practice Address - Street 1:804 E HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2254
Practice Address - Country:US
Practice Address - Phone:254-547-9755
Practice Address - Fax:254-547-9858
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX452281835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist