MEDICARE: MS. RENEE MICHELLE DEVINE PHARM D

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
1	1835P1200X	Pharmacotherapy Pharmacist	RPH021616	GA

General Provider Information

NPI Number	:	1538167762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE MICHELLE DEVINE PHARM D

Provider Business Mailing Address
First Line	:	1022 ROCK SPRINGS CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2331
Country	:	US
Telephone Number	:	404-817-3622
Fax Number	:	404-712-1394

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:	DEPARTMENT OF PHARMACY EG22
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:	404-712-7505
Fax Number	:	404-712-1394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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