Active NPI
Renee Carol Roadruck, RPH
- Pharmacist
- Shelton, WA
National Provider Identifier
1932294758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00009961
- Practice address
- 512 West Franklin
Neils Pharmacy
Shelton, WA 98584 - Phone
- (360) 426-3327
- Fax
- (360) 427-5223
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00009961 | WA | Primary |
Addresses
Primary practice location
512 West Franklin
Neils Pharmacy
Shelton, WA 98584
Mailing address
1427 Madrona PT Dr
Bremerton, WA 98312
Phone (360) 479-2478
Other names 1
- Miss Renee Carol Bradbury
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00009961 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neils Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932294758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1427 MADRONA PT DR",
"city": "BREMERTON",
"state": "WA",
"postal_code": "98312",
"telephone_number": "360-479-2478",
"fax_number": "360-427-5223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "512 WEST FRANKLIN",
"address_2": "NEILS PHARMACY",
"city": "SHELTON",
"state": "WA",
"postal_code": "98584",
"telephone_number": "360-426-3327",
"fax_number": "360-427-5223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROADRUCK",
"first_name": "RENEE",
"middle_name": "CAROL",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00009961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RENEE",
"last_name": "BRADBURY",
"middle_name": "CAROL",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Shelton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.