Provider Demographics
NPI:1205106119
Name:KOONTZ, STEVEN ELIOT (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ELIOT
Last Name:KOONTZ
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 WINDCHASE CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3032
Mailing Address - Country:US
Mailing Address - Phone:336-869-5256
Mailing Address - Fax:
Practice Address - Street 1:207 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5529
Practice Address - Country:US
Practice Address - Phone:336-633-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist