Provider Demographics
NPI:1194517045
Name:RUSSELL-SCHAUB, RENEE LYNN (CPHT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:RUSSELL-SCHAUB
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 W 16 RD
Mailing Address - Street 2:
Mailing Address - City:MESICK
Mailing Address - State:MI
Mailing Address - Zip Code:49668-9783
Mailing Address - Country:US
Mailing Address - Phone:231-883-4709
Mailing Address - Fax:
Practice Address - Street 1:112 MESICK AVE.
Practice Address - Street 2:PO BOX 8
Practice Address - City:MESICK
Practice Address - State:MI
Practice Address - Zip Code:49668
Practice Address - Country:US
Practice Address - Phone:231-885-1751
Practice Address - Fax:231-885-1998
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303004711183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician