Provider Demographics
NPI:1053299636
Name:PENALBA, EMERSON (PHARMD)
Entity type:Individual
Prefix:
First Name:EMERSON
Middle Name:
Last Name:PENALBA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMERSON
Other - Middle Name:
Other - Last Name:PENALBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:630 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-4000
Practice Address - Country:US
Practice Address - Phone:904-249-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist