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General NPI Number Information
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NPI Number | 1003241621
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Entity Type | Individual
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Provider Name | JEREMY BRANDON RENFROE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 6206 WALDEN PARK DR
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City | SAVANNAH
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State | GA
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Zip | 31410-4907
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Country | US
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Telephone | 731-614-0259
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Fax |
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Provider Business Mailing Address
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Address Line | 6206 WALDEN PARK DR
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City | SAVANNAH
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State | GA
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Zip | 31410-4907
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Country | US
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Telephone | 731-614-0259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 36900
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH026902
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License Number State | GA
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