Healthcare Provider Details

I. General information

NPI: 1003386061
Provider Name (Legal Business Name): JEANNE MARIE KUCHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 GLENLIVET DRIVE WEST
FOGELSVILLE PA
18051
US

IV. Provider business mailing address

6565 SAUTERNE DR
MACUNGIE PA
18062-8862
US

V. Phone/Fax

Practice location:
  • Phone: 610-530-3117
  • Fax: 610-530-3119
Mailing address:
  • Phone: 610-297-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040918L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: