Provider Demographics
NPI:1285010215
Name:RENATUS HEALTH LLC
Entity Type:Organization
Organization Name:RENATUS HEALTH LLC
Other - Org Name:TARRYTOWN SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-617-3530
Mailing Address - Street 1:1600 W 38TH ST STE 408
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6407
Mailing Address - Country:US
Mailing Address - Phone:512-617-3530
Mailing Address - Fax:512-617-3531
Practice Address - Street 1:1600 W 38TH ST STE 408
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6407
Practice Address - Country:US
Practice Address - Phone:512-617-3530
Practice Address - Fax:844-965-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31564333600000X, 3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153410OtherPK