Provider Demographics
NPI:1083937064
Name:KOLTIS, KAYCI ANN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KAYCI
Middle Name:ANN
Last Name:KOLTIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 STONE SCHOOL LANE
Mailing Address - Street 2:
Mailing Address - City:SCOTT TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18414
Mailing Address - Country:US
Mailing Address - Phone:570-241-6735
Mailing Address - Fax:
Practice Address - Street 1:431 STONE SCHOOL LANE
Practice Address - Street 2:
Practice Address - City:SCOTT TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18414
Practice Address - Country:US
Practice Address - Phone:570-241-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP442663OtherSTATE LICENSE
PARPI001221OtherIMMUNIZATION LICENSE