Provider Demographics
NPI:1295730265
Name:RUNNINGERS PHARMACY INC
Entity type:Organization
Organization Name:RUNNINGERS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KATHYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-665-5200
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421-0025
Mailing Address - Country:US
Mailing Address - Phone:757-665-1239
Mailing Address - Fax:
Practice Address - Street 1:18465 DUNNE AVE
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-1239
Practice Address - Fax:757-665-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010039203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105388OtherPK
VA010001650Medicaid