MEDICARE: JORDYN AMBER KOONTZ

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	RP459899	PA

General Provider Information

NPI Number	:	1790659092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDYN AMBER KOONTZ

Provider Business Mailing Address
First Line	:	275 S BRYN MAWR AVE APT J8
Second Line	:
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-4238
Country	:	US
Telephone Number	:	937-286-9148
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 LANCASTER AVE
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-2515
Country	:	US
Telephone Number	:	610-341-0951
Fax Number	:

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

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	10/01/2025

Similar Medicare Providers

1295781292 — ACME MARKETS INC
Practice Location Address:

700 LANCASTER AVE
WAYNE, PA
19087-2515

Practice Phone: 610-341-0951
Practice Fax: 610-341-0960

1477876258 — MR. MICHAEL A WOLBRAMSKY RPH
Practice Location Address:

704 W LANCASTER AVENUE
WAYNE, PA
19087-2515

Practice Phone: 610-687-2541
Practice Fax: 610-687-1468

1013976950 — MARIA KRACH R.D.
Practice Location Address:

2515 MILL POND CT.
FORT WAYNE, IN
46804

Practice Phone: 260-436-1312
Practice Fax: 260-436-1312

1154358489 — SOSHELLA JALALUDDIN O.D.
Practice Location Address:

2154 WAYNE AVE
ABINGTON, PA
19001-2515

Practice Phone: 215-887-7574
Practice Fax:

1942211461 — WAL-MART STORES EAST LP
Practice Location Address:

7502 SOUTHTOWN XING
FORT WAYNE, IN
46816-2515

Practice Phone: 260-441-7083
Practice Fax:

1073613337 — WAL-MART STORES EAST, LP
Practice Location Address:

7502 SOUTHTOWN XING
FORT WAYNE, IN
46816-2515

Practice Phone: 260-441-7087
Practice Fax:

Directions to “ JORDYN AMBER KOONTZ ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.