Provider Demographics
NPI:1578855458
Name:KURUP, RENNY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RENNY
Middle Name:
Last Name:KURUP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2605
Mailing Address - Country:US
Mailing Address - Phone:312-624-9397
Mailing Address - Fax:312-624-8826
Practice Address - Street 1:1460 N HALSTED ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2605
Practice Address - Country:US
Practice Address - Phone:312-624-9397
Practice Address - Fax:312-624-8826
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist