Provider Demographics
NPI:1215205844
Name:KOENINGS, REBECCA (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KOENINGS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11521 S LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8457
Mailing Address - Country:US
Mailing Address - Phone:913-839-1009
Mailing Address - Fax:
Practice Address - Street 1:13450 S BLACKBOB RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1503
Practice Address - Country:US
Practice Address - Phone:913-829-3176
Practice Address - Fax:913-829-9115
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS114034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist