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General NPI Number Information
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NPI Number | 1568715159
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Entity Type | Organization
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Legal Business Name | RENEW COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 7105 CROSSROADS BLVD STE 105
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City | BRENTWOOD
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State | TN
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Zip | 37027-2806
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Country | US
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Telephone | 615-891-7776
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Fax | 615-891-7393
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Provider Business Mailing Address
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Address Line | 7105 CROSSROADS BLVD SUITE 105
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City | BRENTWOOD
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State | TN
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Zip | 37027-2806
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Country | US
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Telephone | 615-891-7776
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Fax | 615-891-7393
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Authorized Official
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Title or Position | OWNER
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Name | JAMES ANDERSON
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Credential |
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Telephone | 615-891-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 5083
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License Number State | TN
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