Provider Demographics
NPI:1831472554
Name:PICKERING, PENNY DENISE
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:DENISE
Last Name:PICKERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 OVERLOOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2331
Mailing Address - Country:US
Mailing Address - Phone:251-380-3181
Mailing Address - Fax:251-380-3185
Practice Address - Street 1:5304 OVERLOOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2331
Practice Address - Country:US
Practice Address - Phone:251-380-3181
Practice Address - Fax:251-380-3185
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist