Provider Demographics
NPI:1013241546
Name:RENEW RX LLC
Entity Type:Organization
Organization Name:RENEW RX LLC
Other - Org Name:RENEW RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-513-5444
Mailing Address - Street 1:9962 BROOK RD
Mailing Address - Street 2:#601
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6501
Mailing Address - Country:US
Mailing Address - Phone:888-513-5444
Mailing Address - Fax:804-550-5173
Practice Address - Street 1:9555 KINGS CHARTER DR STE D
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7994
Practice Address - Country:US
Practice Address - Phone:804-550-5143
Practice Address - Fax:804-550-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010043103336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4841892OtherNCPDP PROVIDER IDENTIFICATION NUMBER