Provider Demographics
NPI:1558678938
Name:PASTORI, PENNY MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:MARIE
Last Name:PASTORI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3004
Mailing Address - Country:US
Mailing Address - Phone:503-522-6568
Mailing Address - Fax:
Practice Address - Street 1:1201 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-723-9007
Practice Address - Fax:360-687-8192
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53553183500000X
OR8826183500000X, 1835P0018X
WAPH60338665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist