Provider Demographics
NPI:1376131763
Name:REN, STEVEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:REN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 44TH DR
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4202
Mailing Address - Country:US
Mailing Address - Phone:718-736-2200
Mailing Address - Fax:718-736-2222
Practice Address - Street 1:2529 44TH DR
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4202
Practice Address - Country:US
Practice Address - Phone:718-736-2200
Practice Address - Fax:718-736-2222
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist