1942319025 NPI number — PENNY RENEE HUTCHISON RPH

Table of content: PENNY RENEE HUTCHISON RPH (NPI 1942319025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942319025 NPI number — PENNY RENEE HUTCHISON RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTCHISON
Provider First Name:
PENNY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRIS
Provider Other First Name:
PENNY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942319025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1833 SEASONS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRATTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36066-6153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-312-3822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3625 HIGHWAY 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLBROOK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36054-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-285-8336
Provider Business Practice Location Address Fax Number:
334-285-5298
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10886 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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