Individual
MR. LARRY PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2455 SALEM RD SE, CONYERS, GA 30013-6316
(770) 922-3507
(770) 922-4498
Mailing address
2455 SALEM RD SE, CONYERS, GA 30013-6316
(770) 922-3507
(770) 922-4498
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13093
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13093
STATE LICENSE
GA
Enumeration date
01/23/2017
Last updated
01/23/2017
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