Provider Demographics
NPI:1679874689
Name:PENRO INC
Entity Type:Organization
Organization Name:PENRO INC
Other - Org Name:PENRO SPECIALTY COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:802-879-1100
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-0930
Mailing Address - Country:US
Mailing Address - Phone:802-879-1100
Mailing Address - Fax:802-878-2692
Practice Address - Street 1:987 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-7660
Practice Address - Country:US
Practice Address - Phone:802-879-1100
Practice Address - Fax:802-878-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT038-00032963336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy