Provider Demographics
NPI:1114157880
Name:RENAUER, MARIE MARCELINO (PHARMD, MBA, BCACP)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MARCELINO
Last Name:RENAUER
Suffix:
Gender:F
Credentials:PHARMD, MBA, BCACP
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:ANTOINETTE
Other - Last Name:MARCELINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MBA, BCACP
Mailing Address - Street 1:200 ORCHARD ST STE 209
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5365
Mailing Address - Country:US
Mailing Address - Phone:203-680-6323
Mailing Address - Fax:
Practice Address - Street 1:200 ORCHARD ST STE 209
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-680-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21046183500000X
CTPCT.00139121835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist