Provider Demographics
NPI:1255747879
Name:PENNINGTON, MATTHEW LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LEE
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-4776
Mailing Address - Country:US
Mailing Address - Phone:325-201-0148
Mailing Address - Fax:
Practice Address - Street 1:6250 US HIGHWAY 83
Practice Address - Street 2:PHARMACY
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5215
Practice Address - Country:US
Practice Address - Phone:325-428-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist