Provider Demographics
NPI:1336423979
Name:FENNEMAN, RONALD L (PHARMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:FENNEMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-4072
Mailing Address - Country:US
Mailing Address - Phone:765-284-3933
Mailing Address - Fax:765-284-4086
Practice Address - Street 1:400 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-4072
Practice Address - Country:US
Practice Address - Phone:765-284-3933
Practice Address - Fax:765-284-4086
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021851A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist