Provider Demographics
NPI:1821399502
Name:RENNELL, AIMEE ADAMO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:ADAMO
Last Name:RENNELL
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 1:13255 MAPLE LAWN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2305
Mailing Address - Country:US
Mailing Address - Phone:720-579-7029
Mailing Address - Fax:
Practice Address - Street 1:3097 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1028
Practice Address - Country:US
Practice Address - Phone:248-393-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist