Provider Demographics
NPI:1881921864
Name:RENFREW, RACHAEL R (PHARMD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:R
Last Name:RENFREW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:R
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2404
Mailing Address - Country:US
Mailing Address - Phone:515-263-1782
Mailing Address - Fax:515-263-8134
Practice Address - Street 1:1300 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2404
Practice Address - Country:US
Practice Address - Phone:515-263-1782
Practice Address - Fax:515-263-8134
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0233916Medicaid
IA0233916Medicaid