Healthcare Provider Details

I. General information

NPI: 1114157880
Provider Name (Legal Business Name): MARIE MARCELINO RENAUER PHARMD, MBA, BCACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE ANTOINETTE MARCELINO PHARMD, MBA, BCACP

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ORCHARD ST STE 209
NEW HAVEN CT
06511
US

IV. Provider business mailing address

200 ORCHARD ST STE 209
NEW HAVEN CT
06511-5365
US

V. Phone/Fax

Practice location:
  • Phone: 203-680-6323
  • Fax:
Mailing address:
  • Phone: 203-680-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21046
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPCT.0013912
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: