Provider Demographics
NPI:1255938155
Name:PEZZELLA, PENELOPE L (RPH)
Entity type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:L
Last Name:PEZZELLA
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 1:1312 WOODY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2245
Mailing Address - Country:US
Mailing Address - Phone:757-647-1877
Mailing Address - Fax:
Practice Address - Street 1:2145 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4426
Practice Address - Country:US
Practice Address - Phone:757-545-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist