Provider Demographics
NPI:1255616520
Name:KING, RENEE D (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:D
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24942 RAVENSWOOD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3238
Mailing Address - Country:US
Mailing Address - Phone:949-770-9775
Mailing Address - Fax:949-206-1339
Practice Address - Street 1:24081 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3103
Practice Address - Country:US
Practice Address - Phone:949-206-9632
Practice Address - Fax:949-206-1339
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist