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General NPI Number Information
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NPI Number | 1790659092
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Entity Type | Individual
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Provider Name | JORDYN AMBER KOONTZ
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Gender | Female
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 700 LANCASTER AVE
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City | WAYNE
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State | PA
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Zip | 19087-2515
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Country | US
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Telephone | 610-341-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 275 S BRYN MAWR AVE APT J8
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City | BRYN MAWR
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State | PA
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Zip | 19010-4238
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Country | US
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Telephone | 937-286-9148
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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 | RP459899
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License Number State | PA
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