MEDICARE: AMBER KOENIGSKNECHT 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1578986204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER KOENIGSKNECHT PHARM.D.

Provider Business Mailing Address
First Line	:	13677 W TOWNSEND RD
Second Line	:
City	:	FOWLER
State	:	MI
Zip	:	48835-9265
Country	:	US
Telephone Number	:	989-640-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W TOWNSEND RD
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-9200
Country	:	US
Telephone Number	:	899-403-6090
Fax Number	:

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

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	10/18/2023

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