Provider Demographics
NPI:1497039747
Name:ABJORNSON, RENEE LYNN
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:ABJORNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1758
Mailing Address - Country:US
Mailing Address - Phone:401-781-7930
Mailing Address - Fax:401-781-5045
Practice Address - Street 1:533 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1758
Practice Address - Country:US
Practice Address - Phone:401-781-7930
Practice Address - Fax:401-781-5045
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist