Active NPI
Frederick Victor Penna III, PHARMD
- Pharmacist
- Amityville, NY
National Provider Identifier
1083124838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 063460
- Practice address
- 355 Broadway # a
Amityville, NY 11701-2715 - Phone
- (631) 842-4647
- Fax
- (631) 842-9493
- NPI assigned
- Oct 6, 2017
- Sex
- Male
- 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 | 063460 | NY | Primary |
Addresses
Primary practice location
355 Broadway # a
Amityville, NY 11701-2715
Mailing address
75 Intervale Ave
Farmingdale, NY 11735-5331
Phone (516) 420-0319
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 063460 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1083124838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 INTERVALE AVE",
"city": "FARMINGDALE",
"state": "NY",
"postal_code": "117355331",
"telephone_number": "516-420-0319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 BROADWAY # A",
"city": "AMITYVILLE",
"state": "NY",
"postal_code": "117012715",
"telephone_number": "631-842-4647",
"fax_number": "631-842-9493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNA",
"first_name": "FREDERICK",
"middle_name": "VICTOR",
"name_suffix": "III",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "063460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amityville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.