Provider Demographics
NPI:1588294458
Name:RENNEKAMP, JENNIFER (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RENNEKAMP
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 1:4976 E COUNTY ROAD 800 N
Mailing Address - Street 2:
Mailing Address - City:SUNMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47041-8024
Mailing Address - Country:US
Mailing Address - Phone:812-623-2654
Mailing Address - Fax:
Practice Address - Street 1:2325 N STATE HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-9251
Practice Address - Country:US
Practice Address - Phone:812-352-1780
Practice Address - Fax:812-352-1781
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020500A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist