Provider Demographics
NPI:1902421266
Name:PENROD, KARL STEVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:STEVEN
Last Name:PENROD
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 1:2096 GOLDEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8617
Mailing Address - Country:US
Mailing Address - Phone:319-400-2162
Mailing Address - Fax:
Practice Address - Street 1:157 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7660
Practice Address - Country:US
Practice Address - Phone:563-588-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist