Provider Demographics
NPI:1003386061
Name:KUCHTA, JEANNE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:KUCHTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 SAUTERNE DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8862
Mailing Address - Country:US
Mailing Address - Phone:610-297-6194
Mailing Address - Fax:
Practice Address - Street 1:7801 GLENLIVET DRIVE WEST
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051
Practice Address - Country:US
Practice Address - Phone:610-530-3117
Practice Address - Fax:610-530-3119
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040918L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist