Provider Demographics
NPI:1376993691
Name:RENO, PAUL R (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:RENO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2223
Mailing Address - Country:US
Mailing Address - Phone:231-627-4337
Mailing Address - Fax:231-627-2429
Practice Address - Street 1:1150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2223
Practice Address - Country:US
Practice Address - Phone:231-627-4337
Practice Address - Fax:231-627-2429
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist