Provider Demographics
NPI:1689261505
Name:RENKEL, LAURA ELLEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELLEN
Last Name:RENKEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4862
Mailing Address - Country:US
Mailing Address - Phone:216-271-0970
Mailing Address - Fax:
Practice Address - Street 1:6301 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4862
Practice Address - Country:US
Practice Address - Phone:216-271-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist