Active NPI
Marina Petrenko, PHARMACIST
- Pharmacist
- Baldwin, GA
National Provider Identifier
1053692913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 019894
- Practice address
- 184 Professional Dr
Baldwin, GA 30511-4012 - Phone
- (706) 894-2716
- Fax
- (706) 894-2717
- NPI assigned
- Sep 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 019894 | GA | Primary |
Addresses
Primary practice location
184 Professional Dr
Baldwin, GA 30511-4012
Mailing address
309 Woodland Cir
Dawsonville, GA 30534-7245
Phone (404) 918-9089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019894 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Flowery Branch, GA
- NPI 1952534455
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671494400000",
"number": "1053692913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 WOODLAND CIR",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305347245",
"telephone_number": "404-918-9089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "184 PROFESSIONAL DR",
"city": "BALDWIN",
"state": "GA",
"postal_code": "305114012",
"telephone_number": "706-894-2716",
"fax_number": "706-894-2717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRENKO",
"first_name": "MARINA",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-06",
"last_updated": "2022-12-20",
"certification_date": "2022-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "019894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baldwin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.