Provider Demographics
NPI:1578721460
Name:RENNER'S PHARMACY
Entity Type:Organization
Organization Name:RENNER'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CORPORATE HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-554-5122
Mailing Address - Street 1:781 CHESTNUT RIDGE RD
Mailing Address - Street 2:RENNER'S PHARMACY
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2730
Mailing Address - Country:US
Mailing Address - Phone:304-598-5455
Mailing Address - Fax:304-598-5453
Practice Address - Street 1:781 CHESTNUT RIDGE RD
Practice Address - Street 2:RENNER'S PHARMACY
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2730
Practice Address - Country:US
Practice Address - Phone:304-598-5455
Practice Address - Fax:304-598-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP552266333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy