Provider Demographics
NPI:1548673817
Name:RENARD, BERNARD J (RPH)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:RENARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 SILVERLEAF CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4214
Mailing Address - Country:US
Mailing Address - Phone:419-348-7795
Mailing Address - Fax:216-321-6334
Practice Address - Street 1:7406 SILVERLEAF CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4214
Practice Address - Country:US
Practice Address - Phone:419-348-7795
Practice Address - Fax:216-321-6334
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist