Provider Demographics
NPI:1952350274
Name:BARTON, PENNY RUTH (RPH)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:RUTH
Last Name:BARTON
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 1:2516 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5148
Mailing Address - Country:US
Mailing Address - Phone:618-467-0825
Mailing Address - Fax:618-467-0851
Practice Address - Street 1:2516 STATE ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5148
Practice Address - Country:US
Practice Address - Phone:618-467-0825
Practice Address - Fax:618-467-0851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371414225001Medicaid
IL371414225001Medicaid