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General NPI Number Information
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NPI Number | 1205375011
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Entity Type | Individual
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Provider Name | COREY LEE KOONCE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 14520 JOHN REX BLVD
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City | RALEIGH
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State | NC
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Zip | 27614-8592
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Country | US
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Telephone | 919-556-2434
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Fax |
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Provider Business Mailing Address
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Address Line | 14520 JOHN REX BLVD
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City | RALEIGH
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State | NC
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Zip | 27614-8592
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Country | US
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Telephone | 919-556-2434
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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 | 23744
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202212187
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License Number State | VA
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