Provider Demographics
NPI:1376153585
Name:ILENRE, RITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:ILENRE
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 1:194 CHAMPION WAY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-5247
Mailing Address - Country:US
Mailing Address - Phone:770-875-1764
Mailing Address - Fax:
Practice Address - Street 1:194 CHAMPION WAY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-5247
Practice Address - Country:US
Practice Address - Phone:770-875-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0310681835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology