MEDICARE: DR. KAYCI ANN KOLTIS PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP442663	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP442663	OTHER	PA	STATE LICENSE
2	RPI001221	OTHER	PA	IMMUNIZATION LICENSE

General Provider Information

NPI Number	:	1083937064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAYCI ANN KOLTIS PHARM D

Provider Business Mailing Address
First Line	:	431 STONE SCHOOL LANE
Second Line	:
City	:	SCOTT TOWNSHIP
State	:	PA
Zip	:	18414
Country	:	US
Telephone Number	:	570-241-6735
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 STONE SCHOOL LANE
Second Line	:
City	:	SCOTT TOWNSHIP
State	:	PA
Zip	:	18414
Country	:	US
Telephone Number	:	570-241-6735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	03/05/2010

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