Healthcare Provider Details

I. General information

NPI: 1154065910
Provider Name (Legal Business Name): RUNE ESPENHEIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 WILLOW CREEK RD APT 343
PRESCOTT AZ
86301-6798
US

IV. Provider business mailing address

3139 WILLOW CREEK RD APT 343
PRESCOTT AZ
86301-6798
US

V. Phone/Fax

Practice location:
  • Phone: 480-622-6545
  • Fax:
Mailing address:
  • Phone: 480-622-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018062
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: