Provider Demographics
NPI:1609159268
Name:PENNINGTON, LON PRESTON (DPH)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:PRESTON
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7648 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-3802
Mailing Address - Country:US
Mailing Address - Phone:405-745-4470
Mailing Address - Fax:
Practice Address - Street 1:1427 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5245
Practice Address - Country:US
Practice Address - Phone:405-273-8520
Practice Address - Fax:405-273-0542
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist