Provider Demographics
NPI:1932294758
Name:ROADRUCK, RENEE CAROL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:CAROL
Last Name:ROADRUCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:CAROL
Other - Last Name:BRADBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1427 MADRONA PT DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:360-479-2478
Mailing Address - Fax:360-427-5223
Practice Address - Street 1:512 WEST FRANKLIN
Practice Address - Street 2:NEILS PHARMACY
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-426-3327
Practice Address - Fax:360-427-5223
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist