Provider Demographics
NPI:1811684566
Name:KUNZ, AMMON (PHARMD CANDIDATE)
Entity type:Individual
Prefix:
First Name:AMMON
Middle Name:
Last Name:KUNZ
Suffix:
Gender:M
Credentials:PHARMD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 NW ORCHARD AVE APT 173
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5184
Mailing Address - Country:US
Mailing Address - Phone:402-209-5673
Mailing Address - Fax:
Practice Address - Street 1:3405 NW ORCHARD AVE APT 173
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5184
Practice Address - Country:US
Practice Address - Phone:402-209-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0014106183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician