Basic Information
| Provider Information | |||||||||
| NPI: | 1386714244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LILES | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 73 BOX 1002 | ||||||||
| Address2: | |||||||||
| City: | VANCEBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411799408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067960009 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ROUTE 1 BOX 1005 | ||||||||
| Address2: | |||||||||
| City: | TOLLESBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067982072 | ||||||||
| FaxNumber: | 6067982222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 011827 | KY | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.