Provider Demographics
NPI:1962815548
Name:RUNYON, COLLIN WOFFORD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:WOFFORD
Last Name:RUNYON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4217
Mailing Address - Country:US
Mailing Address - Phone:336-508-6802
Mailing Address - Fax:
Practice Address - Street 1:219 GILMER ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3809
Practice Address - Country:US
Practice Address - Phone:336-349-3313
Practice Address - Fax:336-349-5555
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist