Provider Demographics
NPI:1811128820
Name:RENNER, ELIZABETH THERESE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:THERESE
Last Name:RENNER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-9559
Mailing Address - Country:US
Mailing Address - Phone:734-439-6856
Mailing Address - Fax:734-439-6864
Practice Address - Street 1:531 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-9559
Practice Address - Country:US
Practice Address - Phone:734-439-6856
Practice Address - Fax:734-439-6864
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036529183500000X
OHRPH.03129478-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist