Provider Demographics
NPI:1053035196
Name:PENDLETON, ANISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-0127
Mailing Address - Country:US
Mailing Address - Phone:270-524-3669
Mailing Address - Fax:
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-0127
Practice Address - Country:US
Practice Address - Phone:270-524-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist