Provider Demographics
NPI:1316039894
Name:BELLANGER, RENEE ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNE
Last Name:BELLANGER
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 1:10448 REMUDA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254
Mailing Address - Country:US
Mailing Address - Phone:210-688-6254
Mailing Address - Fax:210-805-3013
Practice Address - Street 1:4301 BROADWAY
Practice Address - Street 2:CPO 99
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-883-1088
Practice Address - Fax:210-883-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247101835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24710OtherPHARMACIST LICENSE
LA11852OtherPHARMACIST LICENSE