Provider Demographics
NPI:1619018975
Name:RENART, RAYMOND M (RPH,MS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:M
Last Name:RENART
Suffix:
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 118 ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356
Mailing Address - Country:US
Mailing Address - Phone:718-960-3989
Mailing Address - Fax:718-960-3996
Practice Address - Street 1:2175 QUARRY RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1663
Practice Address - Country:US
Practice Address - Phone:718-960-3989
Practice Address - Fax:718-960-3996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist