Provider Demographics
NPI:1821428871
Name:RENNHACK, DENNIS G (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:RENNHACK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1013
Mailing Address - Country:US
Mailing Address - Phone:269-556-2410
Mailing Address - Fax:269-556-2465
Practice Address - Street 1:5019 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1013
Practice Address - Country:US
Practice Address - Phone:269-556-2410
Practice Address - Fax:269-556-2465
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist