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NPI Code Detail

MEDICARE: MRS. RENEE D KING PHARMD

MEDICARE: MRS. RENEE D KING PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist47552CA

General Provider Information

NPI Number : 1255616520
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RENEE D KING PHARMD
Provider Business Mailing Address
First Line : 24942 RAVENSWOOD
Second Line :
City : LAKE FOREST
State : CA
Zip : 92630-3238
Country : US
Telephone Number : 949-770-9775
Fax Number : 949-206-1339
Provider Business Practice Location Address
First Line : 24081 EL TORO RD
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-3103
Country : US
Telephone Number : 949-206-9632
Fax Number : 949-206-1339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2011
Last Update Date : 10/18/2011

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