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NPI Code Detail

MEDICARE: KATHRYN RENNELS

MEDICARE: KATHRYN RENNELS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.295922IL

General Provider Information

NPI Number : 1023618667
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN RENNELS
Provider Business Mailing Address
First Line : 10275 E NORTH SHORE DR
Second Line :
City : EFFINGHAM
State : IL
Zip : 62401-7758
Country : US
Telephone Number : 217-690-5226
Fax Number :
Provider Business Practice Location Address
First Line : 2250 LINCOLN AVE
Second Line :
City : CHARLESTON
State : IL
Zip : 61920-3028
Country : US
Telephone Number : 217-345-9458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2020
Last Update Date : 11/02/2020

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Directions to “ KATHRYN RENNELS ” Practice Location

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