Provider Demographics
NPI:1750676318
Name:KOONTZ, HEATHER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARKETPLACE BLVD
Mailing Address - Street 2:T-2439
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-2407
Mailing Address - Country:US
Mailing Address - Phone:570-743-4931
Mailing Address - Fax:570-743-4941
Practice Address - Street 1:501 MARKETPLACE BLVD
Practice Address - Street 2:T-2439
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-2407
Practice Address - Country:US
Practice Address - Phone:570-743-4931
Practice Address - Fax:570-743-4941
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044897L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist