MEDICARE: MR. ERIC J RENKER CRPH

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
1	183500000X	Pharmacist	PS22517	FL
2	183500000X	Pharmacist	PU3905	FL

General Provider Information

NPI Number	:	1134348279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC J RENKER CRPH

Provider Business Mailing Address
First Line	:	3147 SATURN RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-7032
Country	:	US
Telephone Number	:	352-540-9019
Fax Number	:	352-540-9019

Provider Business Practice Location Address
First Line	:	3147 SATURN RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-7032
Country	:	US
Telephone Number	:	352-540-9019
Fax Number	:	352-540-9019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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