Provider Demographics
NPI:1831700525
Name:EFFOE, RENE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:EFFOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:EFFOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1313 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2533
Mailing Address - Country:US
Mailing Address - Phone:302-658-1381
Mailing Address - Fax:
Practice Address - Street 1:1313 N UNION ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2533
Practice Address - Country:US
Practice Address - Phone:302-658-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist