Provider Demographics
NPI:1093008526
Name:SOBAN, RENEE MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:SOBAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7036 BRIGHTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7971
Mailing Address - Country:US
Mailing Address - Phone:704-545-3845
Mailing Address - Fax:704-545-3250
Practice Address - Street 1:7036 BRIGHTON PARK DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7971
Practice Address - Country:US
Practice Address - Phone:757-545-3845
Practice Address - Fax:757-545-3250
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist