STACIE LYNN PENKOVA


Address: 14th Medical Group, 201 Independence Drive, Columbus Afb, MS 39710
Phone: 6624342273

STACIE LYNN PENKOVA (NPI# 1699372938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1699372938
Entity Type Individual
Full Name STACIE LYNN PENKOVA
Credential PHARMD
Practice Address 14th Medical Group
201 Independence Drive
Columbus Afb
MS 39710
Practice Telephone 6624342273
Mailing Telephone 6624342273
Enumeration Date 2020-10-08
Last Update Date 2020-10-08
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1835P0018X Pharmacist
Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
E-008947 MS Pharmacy Service Providers

Office Location

Street Address 14TH MEDICAL GROUP
201 INDEPENDENCE DRIVE
City COLUMBUS AFB
State MS
Zip Code 39710

Providers in the same location

NPI Name Taxonomy Address Enumeration
1558653063 Steven Thomas Fosmire Preventive Medicine 14th Medical Group, 201 Independence Dr., Ste 2255, Columbus Afb, MS 39710 2011-05-03
1225457534 Kenneth Richard Taylor Preventive Medicine 14th Medical Group, 201 Independence Drive, Columbus Afb, MS 39710 2014-04-15

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1457311573 Benjamin Jordan Franklin Optometrist 14 Medical Group, 201 Independence Dr Ste 235, Columbus Afb, MS 39710 2006-03-24
1396713194 Kirk Tracy Moss Family Medicine 14th Mdg, 201 Independence Dr, Columbus Afb, MS 39710 2006-03-09
1659367266 Paul H Nelson Family Medicine 201 Independence Dr, 14th Medical Group Ste 235, Columbus Afb, MS 39710 2005-09-20
1467447201 James Henry Heriot Internal Medicine 201 Independence Drive, 14th Medical Group/sgoq, Columbus Afb, MS 39710 2005-09-19
1932696713 James Tyler Bates Family Medicine 201 Independence, Columbus, MS 39710 2018-04-17
1972964591 Lauren Beers Physical Therapist 201 Independence, Columbus, MS 39710 2016-03-09
1558740019 William Jennings Amador Family Medicine 201 Independence Drive, 14th Medical Group, Columbus Afb, MS 39710 2015-05-29
1992117378 Jennifer Bryant Williams Social Worker 201 Independence, Columbus, MS 39710 2014-05-20
1477845261 Richard Joseph Levitre Psychiatry & Neurology 14th Medical Group 201 Independence Drive, Columbus, MS 39710 2011-05-11
1861582710 Gwendolyn Wheeler Physician Assistant 201 Independence Drive, 14 Mdg, Columbus Afb, MS 39710 2006-10-13
Find all providers in zip 39710

Taxonomy Information

Taxonomy Code 1835P0018X
Grouping Pharmacy Service Providers
Classification Pharmacist
Specialization Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Taxonomy Definition

Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management.
Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1467085274 Kenneth Martin Pharmacist 1811 West Govt St, Brandon, MS 39042-2106 2020-02-20
1316585581 Deborah Magoun Rosenbaum Pharmacist [email protected], 4910 I-55 North, Jackson, MS 39211 2019-12-18
1326686932 Joshua Brett Manning Pharmacist Kroger, 2340 Highway 15 N, Laurel, MS 39440-1831 2019-12-13
1023585296 Brenda M Wise Pharmacist 301 Fisher St # 2b, Biloxi, MS 39534-2508 2018-10-25
1508311028 Koshy Mathew Pharmacist 122 Mcdill Cv, Madison, MS 39110-6562 2016-08-25
1992106413 Roland Mullins Jr. Pharmacist 301 Fisher St Rm 309b, Keesler Afb, MS 39534-2508 2014-09-16
1124432679 Tara Lynn Felder Pharmacist 1121 Hwy 98/51, Summit, MS 39666 2014-06-12
1912333956 Carman G Cochran Pharmacist 68 Buffalo Rd, Mc Lain, MS 39456-2330 2013-09-23
1902239197 Melanie Hammill Bishop Pharmacist 427 Ms Highway 51 North, Brookhaven, MS 39601 2013-08-12
1578833299 April Malone Pharmacist 208 S 27th Ave, Hattiesburg, MS 39401-7173 2012-01-11
Find all providers with the same taxonomy

Competitor

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City COLUMBUS AFB
Zip Code 39710

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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