Provider Demographics
NPI:1508141391
Name:PENNE, CAROLINE S (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:S
Last Name:PENNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:S
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 W CHAMBERS ST RM 1801
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1650
Mailing Address - Country:US
Mailing Address - Phone:414-447-2585
Mailing Address - Fax:
Practice Address - Street 1:5000 W CHAMBERS ST RM 1801
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-447-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16432040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist