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).
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 |
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 |
Street Address |
14TH MEDICAL GROUP 201 INDEPENDENCE DRIVE |
City | COLUMBUS AFB |
State | MS |
Zip Code | 39710 |
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 |
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 Code | 1835P0018X |
Grouping | Pharmacy Service Providers |
Classification | Pharmacist |
Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
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] |
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 |
City | COLUMBUS AFB |
Zip Code | 39710 |
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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.