Provider Demographics
NPI:1356622310
Name:RUNCIE, KAEANNA ALLANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAEANNA
Middle Name:ALLANA
Last Name:RUNCIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COUNTY ROAD 17A W
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2164
Mailing Address - Country:US
Mailing Address - Phone:863-452-3040
Mailing Address - Fax:
Practice Address - Street 1:1514 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2476
Practice Address - Country:US
Practice Address - Phone:863-292-4281
Practice Address - Fax:863-292-4291
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist