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General NPI Number Information
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NPI Number | 1093237026
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Entity Type | Individual
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Provider Name | REBEKAH ASHLYN KOON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 12845 MAIN ST
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City | WILLISTON
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State | SC
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Zip | 29853-2711
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Country | US
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Telephone | 803-266-4345
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Fax |
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Provider Business Mailing Address
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Address Line | 2318 CHAPIN RD
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City | CHAPIN
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State | SC
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Zip | 29036-7821
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Country | US
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Telephone | 803-206-4506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 37179
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License Number State | SC
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