Renegade Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

RENEGADE PHARMACY INC.

Practice address

RT 10 Cook Parkway/18 Logan Street
Oceana, WV 24870

Phone

(304) 682-0444

Fax

(304) 682-0447

NPI assigned

Aug 15, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jenny Lee Cunningham

Title

Owner

Phone

(304) 994-0635

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Devonna Lou West, RPH

  • Pharmacist
  • Oceana, WV
  • NPI 1326909755
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1154977023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "OCEANA",
            "state": "WV",
            "postal_code": "248700069",
            "telephone_number": "304-682-0444",
            "fax_number": "304-682-0447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RT 10 COOK PARKWAY/18 LOGAN STREET",
            "city": "OCEANA",
            "state": "WV",
            "postal_code": "24870",
            "telephone_number": "304-682-0444",
            "fax_number": "304-682-0447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADE PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-994-0635",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Perry, FNP-C
• Seth Prince, DDS
• Professional Sleep Lab, Inc.
• Shelby Rakes
• Ginger Lea Reed
• Rebecca Ann Repass
• Stephanie Michelle Riddle
• Raelena Robertson
• Frank Dakota Sammons, RPH
• Franklin Pierce Short Jr., D.D.S.

• Community/Retail Pharmacy in Oceana, WV
• Providers in Oceana, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.