Provider Demographics
NPI:1134348279
Name:RENKER, ERIC J (CRPH)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:RENKER
Suffix:
Gender:M
Credentials:CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 SATURN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-7032
Mailing Address - Country:US
Mailing Address - Phone:352-540-9019
Mailing Address - Fax:352-540-9019
Practice Address - Street 1:3147 SATURN RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-7032
Practice Address - Country:US
Practice Address - Phone:352-540-9019
Practice Address - Fax:352-540-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22517183500000X
FLPU3905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist