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General NPI Number Information
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NPI Number | 1285010215
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Entity Type | Organization
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Legal Business Name | RENATUS HEALTH LLC
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 1600 W 38TH ST STE 408
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City | AUSTIN
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State | TX
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Zip | 78731-6407
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Country | US
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Telephone | 512-617-3530
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Fax | 844-965-9846
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Provider Business Mailing Address
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Address Line | 1600 W 38TH ST STE 408
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City | AUSTIN
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State | TX
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Zip | 78731-6407
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Country | US
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Telephone | 512-617-3530
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Fax | 512-617-3531
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARK NEWBERRY
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Credential |
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Telephone | 512-617-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 31564
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31564
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 31564
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License Number State | TX
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