Provider Demographics
NPI:1417327941
Name:PENANO, MATT JOSPEH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:JOSPEH
Last Name:PENANO
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 1:2710 DEL PRADO BLVD S UNIT 2-308
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5788
Mailing Address - Country:US
Mailing Address - Phone:239-834-3793
Mailing Address - Fax:
Practice Address - Street 1:2710 DEL PRADO BLVD S UNIT 2-308
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5788
Practice Address - Country:US
Practice Address - Phone:561-203-9071
Practice Address - Fax:201-849-7853
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist