Provider Demographics
NPI:1669771697
Name:PENLEY, ANGIE (RPH)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:PENLEY
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 1:566 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0530
Mailing Address - Country:US
Mailing Address - Phone:706-864-7641
Mailing Address - Fax:
Practice Address - Street 1:566 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0530
Practice Address - Country:US
Practice Address - Phone:706-864-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist