Healthcare Provider Details

I. General information

NPI: 1346855657
Provider Name (Legal Business Name): KIM ELLEN RUNGE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMONWEALTH HEALTH CENTER 1 NAVY HILL DR
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 10003 PMB 81
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax:
Mailing address:
  • Phone: 670-783-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3136
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: