Provider Demographics
NPI:1609398148
Name:PENNISI, TAYLOR GREENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:GREENE
Last Name:PENNISI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:AMANDA
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 SUMMERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7704
Mailing Address - Country:US
Mailing Address - Phone:803-649-5300
Mailing Address - Fax:803-649-0056
Practice Address - Street 1:102 SUMMERWOOD WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7704
Practice Address - Country:US
Practice Address - Phone:803-649-5300
Practice Address - Fax:803-649-0056
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC371661835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC37166OtherPHARMACIST LICENSE