Provider Demographics
NPI:1780985986
Name:RUNSVOLD, CYDNEY JUDITH (RPH)
Entity type:Individual
Prefix:
First Name:CYDNEY
Middle Name:JUDITH
Last Name:RUNSVOLD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1405
Mailing Address - Country:US
Mailing Address - Phone:701-235-5543
Mailing Address - Fax:701-298-0112
Practice Address - Street 1:2522 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1405
Practice Address - Country:US
Practice Address - Phone:701-235-5543
Practice Address - Fax:701-298-0112
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist