Provider Demographics
NPI:1609389717
Name:PENN, MONICA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:PENN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 BRAHMS CMN UNIT 204
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4672
Mailing Address - Country:US
Mailing Address - Phone:512-731-7553
Mailing Address - Fax:
Practice Address - Street 1:2140 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4052
Practice Address - Country:US
Practice Address - Phone:408-246-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist