Provider Demographics
NPI:1568784262
Name:PENNINGTON, RANDY WILLIAM (PD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:WILLIAM
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 GENERAL GEORGE PATTON DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7250
Mailing Address - Country:US
Mailing Address - Phone:615-791-8679
Mailing Address - Fax:615-791-7666
Practice Address - Street 1:1897 GENERAL GEORGE PATTON DR
Practice Address - Street 2:SUITE 112
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7250
Practice Address - Country:US
Practice Address - Phone:615-791-8679
Practice Address - Fax:615-791-7666
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1467401315OtherNPI