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General NPI Number Information
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NPI Number | 1437810132
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Entity Type | Individual
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Provider Name | MARANDA GRACE SORENSEN RENOUARD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 2735 SILVER CREEK RD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7924
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Country | US
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Telephone | 928-763-0258
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 S NEEDLES HWY APT 94
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City | LAUGHLIN
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State | NV
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Zip | 89029-0163
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Country | US
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Telephone |
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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 | S025519
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License Number State | AZ
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