Provider Demographics
NPI:1396927505
Name:BRENENGEN, RENEE KATHRYN (RPH)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:KATHRYN
Last Name:BRENENGEN
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 1:274 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3720
Mailing Address - Country:US
Mailing Address - Phone:507-452-2547
Mailing Address - Fax:507-452-4456
Practice Address - Street 1:274 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3720
Practice Address - Country:US
Practice Address - Phone:507-452-2547
Practice Address - Fax:507-452-4456
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10990183500000X
MN119163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist