BRENTON PENNICOOKE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

ACTIVE

Business

Title

First Name

BRENTON

Last Name

PENNICOOKE

Business Name

BRENTON PENNICOOKE MD

Original Issue Date

11/30/2020

Effective Date

06/21/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63110

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/21/2023