Individual
PETRA ALICE RUNCKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
525 SE WASHINGTON ST, DALLAS, OR 97338-2834
(503) 623-7306
Mailing address
525 SE WASHINGTON ST, DALLAS, OR 97338-2834
(503) 623-7306
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0016209
OR
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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