Provider Demographics
NPI:1427595826
Name:PENNINGTON, LARRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 SALEM RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6316
Mailing Address - Country:US
Mailing Address - Phone:770-922-3507
Mailing Address - Fax:770-922-4498
Practice Address - Street 1:2455 SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6316
Practice Address - Country:US
Practice Address - Phone:770-922-3507
Practice Address - Fax:770-922-4498
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13093OtherSTATE LICENSE