Provider Demographics
NPI:1790227239
Name:MUNTZ, AUTUMN LEE (RPH)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LEE
Last Name:MUNTZ
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 1:701 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2316
Mailing Address - Country:US
Mailing Address - Phone:570-759-5108
Mailing Address - Fax:570-759-5108
Practice Address - Street 1:701 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2316
Practice Address - Country:US
Practice Address - Phone:570-759-5108
Practice Address - Fax:570-759-5108
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035363L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist