Healthcare Provider Details

I. General information

NPI: 1093264186
Provider Name (Legal Business Name): JOSEPH RUNCO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

1822 MULBERRY ST
SCRANTON PA
18510-2369
US

V. Phone/Fax

Practice location:
  • Phone: 570-709-4555
  • Fax:
Mailing address:
  • Phone: 570-709-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP042974L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: