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NPI Code Detail

MEDICARE: MRS. JANICE M KOONTZ RPH

MEDICARE: MRS. JANICE M KOONTZ RPH
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
1183500000XPharmacistPS0021867FL
2183500000XPharmacistRPH015528GA
3183500000XPharmacistRP034835LPA

General Provider Information

NPI Number : 1972840650
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JANICE M KOONTZ RPH
Provider Business Mailing Address
First Line : 13435 S MCCALL RD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33981-6422
Country : US
Telephone Number : 941-697-3255
Fax Number : 941-697-7826
Provider Business Practice Location Address
First Line : 13435 S MCCALL RD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33981-6422
Country : US
Telephone Number : 941-697-3255
Fax Number : 941-697-7826
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2013
Last Update Date : 01/15/2013

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