Provider Demographics
NPI:1356962054
Name:PENNAL, JANEIL
Entity type:Individual
Prefix:
First Name:JANEIL
Middle Name:
Last Name:PENNAL
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:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75653-1476
Mailing Address - Country:US
Mailing Address - Phone:903-658-0004
Mailing Address - Fax:
Practice Address - Street 1:2415 US HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4411
Practice Address - Country:US
Practice Address - Phone:903-657-8596
Practice Address - Fax:903-657-1520
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist