Provider Demographics
NPI:1427121334
Name:RENOWN HEALTH PHARMACY
Entity type:Organization
Organization Name:RENOWN HEALTH PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:775-982-5060
Mailing Address - Street 1:75 PRINGLE WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-8424
Mailing Address - Country:US
Mailing Address - Phone:775-982-5060
Mailing Address - Fax:775-982-5039
Practice Address - Street 1:75 PRINGLE WAY STE 103
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8424
Practice Address - Country:US
Practice Address - Phone:775-982-5060
Practice Address - Fax:775-982-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH007493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2816011Medicaid
NV2904135OtherNCPDP