Provider Demographics
NPI:1851813208
Name:TELL, RENAE C (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:C
Last Name:TELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:C
Other - Last Name:HEUERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9600 VETERANS DR SW # 119
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0003
Mailing Address - Country:US
Mailing Address - Phone:253-582-8440
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR SW # 119
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-2226
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist