Provider Demographics
NPI:1669072393
Name:PENNINGTON, KERI (PHARMD)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:PENNINGTON
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 1:12417 CARNELIAN WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5455
Mailing Address - Country:US
Mailing Address - Phone:405-863-2913
Mailing Address - Fax:
Practice Address - Street 1:5510 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73128-1234
Practice Address - Country:US
Practice Address - Phone:405-946-7847
Practice Address - Fax:405-946-7846
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist