MEDICARE: RENAISSANCE FAMILY PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	A30000897	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0844919	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1568631372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	2618 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2504
Country	:	US
Telephone Number	:	302-798-4801
Fax Number	:	302-798-4804

Provider Business Practice Location Address
First Line	:	2618 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2504
Country	:	US
Telephone Number	:	302-798-4801
Fax Number	:	302-798-4804

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMEY KASHUBA
Credential	:
Telephone Number	:	302-798-4801

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	01/08/2010

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Directions to “RENAISSANCE FAMILY PHARMACY INC ” Practice Location

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