Provider Demographics
NPI:1437810132
Name:RENOUARD, MARANDA GRACE SORENSEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:GRACE SORENSEN
Last Name:RENOUARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARANDA
Other - Middle Name:GRACE
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 S NEEDLES HWY APT 94
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2735 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7924
Practice Address - Country:US
Practice Address - Phone:928-763-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist