MEDICARE: DR. SETH RUNKLE PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	122153	MN
2	183500000X	Pharmacist	26024323A	IN

General Provider Information

NPI Number	:	1649659939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH RUNKLE PHARM D.

Provider Business Mailing Address
First Line	:	2080 FORD PKWY
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 FORD PKWY
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1813
Country	:	US
Telephone Number	:	612-355-3858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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