Renald Alfred Provencher

Primary specialty

PharmacistTaxonomy code 183500000X

License

RP043197R Issued in PA

Practice address

700 Nutt Rd
Phoenixville, PA 19460-3344

Phone

(610) 917-9310

NPI assigned

Nov 6, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1386245116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 HARRISBURG PIKE",
            "city": "CARLISLE",
            "state": "PA",
            "postal_code": "170131607",
            "telephone_number": "610-917-9310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NUTT RD",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194603344",
            "telephone_number": "610-917-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "RENALD",
        "middle_name": "ALFRED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-06",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP043197R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "27216917",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arleta Presock
• Cynthia Pristash
• Project Healing Hive, Inc
• George M Protenic
• Susan Howe Prouty, M.D.
• Jonathon Parker Przybylek, PA-C
• Dannetta Lynn Purnell, LCSW
• Monica Quigley
• Fatima Qureshi, M.D.
• Richard Nicholas Racioppi III, DC

• Pharmacist in Phoenixville, PA
• Providers in Phoenixville, PA by specialty
• Pharmacist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.