Provider Demographics
NPI:1700243268
Name:PENNINGTON, ELYSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
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 1:4452 SHERMAN MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-8429
Mailing Address - Country:US
Mailing Address - Phone:859-393-3397
Mailing Address - Fax:
Practice Address - Street 1:4452 SHERMAN MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-8429
Practice Address - Country:US
Practice Address - Phone:859-393-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist