Provider Demographics
NPI:1225109598
Name:RUNYAN, ANITA KAREN
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:KAREN
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 WOODHAM RD
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-7710
Mailing Address - Country:US
Mailing Address - Phone:850-263-1870
Mailing Address - Fax:
Practice Address - Street 1:1357 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-2467
Practice Address - Country:US
Practice Address - Phone:850-638-0424
Practice Address - Fax:850-638-9371
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist