Provider Demographics
NPI:1386941714
Name:RENNER, WILLIAM ROGER (RPH, MBA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROGER
Last Name:RENNER
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4227
Mailing Address - Country:US
Mailing Address - Phone:304-296-2547
Mailing Address - Fax:304-296-3643
Practice Address - Street 1:381 PATTESON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3270
Practice Address - Country:US
Practice Address - Phone:304-598-2265
Practice Address - Fax:304-598-2843
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist