Organization
PENNOCK PHARMACY
Active
Other names
Pennock Pharmacy - Gun Lake
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA RISNER R. PH (CERTIFIED PHARMACY TECHNICIAN)
(269) 945-1212
Entity
Organization
Contact information
Practice address
12851 W M 179 HWY, WAYLAND, MI 49348-9318
(269) 945-8050
(269) 945-8048
Mailing address
12851 W M 179 HWY, WAYLAND, MI 49348-9318
(269) 945-8050
(269) 945-8048
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009800
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134742
PK
—
Enumeration date
04/20/2012
Last updated
10/13/2015
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