Provider Demographics
NPI:1841341328
Name:ODONNELL, RENEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S STONE HEDGE DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2557
Mailing Address - Country:US
Mailing Address - Phone:908-766-6508
Mailing Address - Fax:360-272-7472
Practice Address - Street 1:195 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2405
Practice Address - Country:US
Practice Address - Phone:973-635-6207
Practice Address - Fax:973-635-6208
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02612600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist