Provider Demographics
NPI:1023330859
Name:PENNE, PATRICIA ELLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:PENNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13450 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2420
Mailing Address - Country:US
Mailing Address - Phone:402-492-2605
Mailing Address - Fax:402-445-2514
Practice Address - Street 1:13450 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2420
Practice Address - Country:US
Practice Address - Phone:402-492-2605
Practice Address - Fax:402-445-2514
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist