Organization
PENNOCK PHARMACY, INC.
Active
Other names
Pennock Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA RISNER (CERTIFIED PHARMACY TECHNICIAN)
(269) 945-1212
Entity
Organization
Contact information
Practice address
1005 W GREEN ST, HASTINGS, MI 49058-1712
(269) 948-3136
(269) 948-3134
Mailing address
1005 W GREEN ST, HASTINGS, MI 49058-1712
(269) 948-3136
(269) 948-3134
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301004710
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639243157
—
MI
01
—
2040181
PK
—
Enumeration date
11/17/2006
Last updated
04/18/2017
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