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SUSAN VIRGINIA KOONTZ PHARMD

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1215586110

Individual Registrant:
 SUSAN VIRGINIA KOONTZ PHARMD
Gender: F
Not Sole Proprietor

Location and contact information for practice:
152 SW SIERRA CT  FORT WHITE, FL 32038-2772 US
Tel: 352-494-9291  Fax: --

Contact information for business:
152 SW SIERRA CT  FORT WHITE, FL 32038-2772 US
Tel: 352-494-9291  Fax: --

Registration Information:
NPI: 1215586110
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
FLPS55210

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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