Healthcare Provider Details

I. General information

NPI: 1861581597
Provider Name (Legal Business Name): RENGAR ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 JAMES CASEY
AUSTIN TX
78745
US

IV. Provider business mailing address

2501 W WILLIAM CANNON DR SUITE 203
AUSTIN TX
78745-5281
US

V. Phone/Fax

Practice location:
  • Phone: 512-444-4938
  • Fax: 512-444-4424
Mailing address:
  • Phone: 512-707-2300
  • Fax: 512-707-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number22770
License Number StateTX

VIII. Authorized Official

Name: MR. RENE F. GARZA
Title or Position: OWNER
Credential: PHARMD
Phone: 512-707-2300