Provider Demographics
NPI:1447255716
Name:PENNEBAKER, GEORGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:PENNEBAKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 PECOS RIVER CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2917
Mailing Address - Country:US
Mailing Address - Phone:916-501-6541
Mailing Address - Fax:
Practice Address - Street 1:11225 PECOS RIVER CT
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2917
Practice Address - Country:US
Practice Address - Phone:916-501-6541
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist