Provider Demographics
NPI:1972840650
Name:KOONTZ, JANICE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
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 1:13435 S MCCALL RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-6422
Mailing Address - Country:US
Mailing Address - Phone:941-697-3255
Mailing Address - Fax:941-697-7826
Practice Address - Street 1:13435 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-6422
Practice Address - Country:US
Practice Address - Phone:941-697-3255
Practice Address - Fax:941-697-7826
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0021867183500000X
GARPH015528183500000X
PARP034835L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist