Provider Demographics
NPI:1831655828
Name:BARENKLAU, PENNY LYNN
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LYNN
Last Name:BARENKLAU
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 1:1750 WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9152
Mailing Address - Country:US
Mailing Address - Phone:541-744-1641
Mailing Address - Fax:
Practice Address - Street 1:1750 WILLOW CREEK CIR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9152
Practice Address - Country:US
Practice Address - Phone:541-744-1641
Practice Address - Fax:541-744-1052
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist