Provider Demographics
NPI:1558486035
Name:BOYETT, PENNY SIMMONS (PHARM D, PA-C)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:SIMMONS
Last Name:BOYETT
Suffix:
Gender:F
Credentials:PHARM D, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 US HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5062
Mailing Address - Country:US
Mailing Address - Phone:205-487-1111
Mailing Address - Fax:205-487-1114
Practice Address - Street 1:1860 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5062
Practice Address - Country:US
Practice Address - Phone:205-487-1111
Practice Address - Fax:205-487-1114
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13386183500000X
ALPA263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No183500000XPharmacy Service ProvidersPharmacist