Pennock Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004710 Issued in MI

Legal business name

PENNOCK PHARMACY, INC.

Practice address

1005 W Green St
Hastings, MI 49058-1712

Phone

(269) 948-3136

Fax

(269) 948-3134

NPI assigned

Nov 17, 2006

Organization subpart

No

Name

Amanda Risner

Title

Certified Pharmacy Technician

Phone

(269) 945-1212

Tax ID family

Corewell Health Pennock Hospital Multisp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pennock Pharmacy

  • Community/Retail Pharmacy
  • Wayland, MI
  • NPI 1538426093
  NPD tax ID

• Pennock Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 18, 2017.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1639243157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-3136",
            "fax_number": "269-948-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-3136",
            "fax_number": "269-948-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNOCK PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "RISNER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CERTIFIED PHARMACY TECHNICIAN",
        "authorized_official_telephone_number": "269-945-1212"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2040181",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639243157",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennock Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pennock Hospital
• Pennock Hospital
• Pennock Hospital Board of Trustees
• Pennock Hospital Board of Trustees
• Pennock Hospital Board of Trustees
• Pennock State Street Center
• Carmen Perry
• Tami Lynn Pettenger, DNP
• James Carl Peurach, DDS
• Pine Rest Christian Mental Health Services

• All providers in Hastings, MI
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.