Laura Runstrom, PHARMD
Individual provider Active NPI Pharmacist · Marshall, MN
NPI 1104241512 · NPPES record last updated Feb 20, 2014
Key facts
- NPI
- 1104241512
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302039398 (MI)
- Practice address
- 809 Southview CT W # 2
Marshall, MN 56258-3105 - Phone
- (231) 649-2806
- NPI assigned
- Feb 20, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302039398 | MI | MD | Pharmacist |
| 121550 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 121550 | MN | |
| Pharmacist | 183500000X | 5302039398 | MI | Yes |
Addresses
Primary practice location
809 Southview CT W # 2
Marshall, MN 56258-3105
Mailing address
809 Southview CT W
#2
Marshall, MN 56258-3105
Other providers in Marshall, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.