Provider Demographics
NPI:1922452796
Name:COONS, PENNY ANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:ANNE
Last Name:COONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 LOCH LOMOND LN
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2926
Mailing Address - Country:US
Mailing Address - Phone:614-354-4664
Mailing Address - Fax:
Practice Address - Street 1:866 LOCH LOMOND LANE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:740-695-6261
Practice Address - Fax:847-396-2595
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist