Provider Demographics
NPI:1386282572
Name:PATTON, RENEE L (RPH)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:PATTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EAGLE RD STE 2108
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6363
Mailing Address - Country:US
Mailing Address - Phone:208-706-0644
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 2108
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6363
Practice Address - Country:US
Practice Address - Phone:208-706-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist