Provider Demographics
NPI:1457899742
Name:RENKAR, LORI (RPH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:RENKAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14407 SUSIE LN
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-7301
Mailing Address - Country:US
Mailing Address - Phone:281-607-3881
Mailing Address - Fax:
Practice Address - Street 1:14407 SUSIE LN
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-7301
Practice Address - Country:US
Practice Address - Phone:281-607-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33057183500000X
OR0011022183500000X
AL19587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist