Healthcare Provider Details

I. General information

NPI: 1912246943
Provider Name (Legal Business Name): RICHARD RENNER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 W LOCUST ST
WILMINGTON OH
45177-2180
US

IV. Provider business mailing address

179 W LOCUST ST
WILMINGTON OH
45177-2180
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-0081
  • Fax: 937-655-8774
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03113616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: