Provider Demographics
NPI:1407132103
Name:RENNAU, JOHN A
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:RENNAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4593
Mailing Address - Country:US
Mailing Address - Phone:708-588-1253
Mailing Address - Fax:708-588-1309
Practice Address - Street 1:6600 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-4593
Practice Address - Country:US
Practice Address - Phone:708-588-1253
Practice Address - Fax:708-588-1309
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist