Provider Demographics
NPI:1376192427
Name:LENNON, JOHUA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHUA
Middle Name:
Last Name:LENNON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 FARLEY CIR APT 109
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6245
Mailing Address - Country:US
Mailing Address - Phone:315-576-7857
Mailing Address - Fax:
Practice Address - Street 1:2830 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-9052
Practice Address - Country:US
Practice Address - Phone:304-856-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0011893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist