Provider Demographics
NPI:1396345591
Name:DANOS, PENNY
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:DANOS
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 1:108 AGARITA CIR
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3183
Mailing Address - Country:US
Mailing Address - Phone:210-273-0453
Mailing Address - Fax:
Practice Address - Street 1:602 CIBOLO VALLEY DR
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3801
Practice Address - Country:US
Practice Address - Phone:210-659-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist