MEDICARE: JONATHAN DOUGLAS KOUNTZ PHARMD

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	2011023693	MO
2	183500000X	Pharmacist	1-16451	KS

General Provider Information

NPI Number	:	1629474408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DOUGLAS KOUNTZ PHARMD

Provider Business Mailing Address
First Line	:	6201 KING HILL AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64504-2063
Country	:	US
Telephone Number	:	816-238-2424
Fax Number	:	816-238-6717

Provider Business Practice Location Address
First Line	:	6201 KING HILL AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64504-2063
Country	:	US
Telephone Number	:	816-238-2424
Fax Number	:	816-238-6717

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

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	11/06/2014

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