Provider Demographics
NPI:1245838002
Name:ENDRES, RENAE SUZANNE
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:SUZANNE
Last Name:ENDRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 HIGHWAY 29 S
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8276
Mailing Address - Country:US
Mailing Address - Phone:320-762-2850
Mailing Address - Fax:320-762-8936
Practice Address - Street 1:4611 HIGHWAY 29 S
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-8276
Practice Address - Country:US
Practice Address - Phone:320-762-2850
Practice Address - Fax:320-762-8936
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist