Provider Demographics
NPI:1457765646
Name:SARDINA, PENNY (PHARMD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:SARDINA
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 1:10 E WILSON BLVD
Mailing Address - Street 2:CVS PHARMACY #1442
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7331
Mailing Address - Country:US
Mailing Address - Phone:301-790-0710
Mailing Address - Fax:
Practice Address - Street 1:10 E WILSON BLVD
Practice Address - Street 2:CVS PHARMACY #1442
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7331
Practice Address - Country:US
Practice Address - Phone:301-790-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist