Provider Demographics
NPI:1316395106
Name:PENNESI, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PENNESI
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 1:5300 MILITARY RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1903
Mailing Address - Country:US
Mailing Address - Phone:716-298-2246
Mailing Address - Fax:
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:PHARMACY
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-298-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039086-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist