Healthcare Provider Details

I. General information

NPI: 1205906682
Provider Name (Legal Business Name): BELINDA JANE RENNO R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SOUTH MAIN STREET
ANTWERP OH
45813-0246
US

IV. Provider business mailing address

PO BOX 246
ANTWERP OH
45813-0246
US

V. Phone/Fax

Practice location:
  • Phone: 419-258-2068
  • Fax: 419-258-2444
Mailing address:
  • Phone: 419-258-2068
  • Fax: 419-258-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03112283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: