Provider Demographics
NPI:1831437326
Name:KOOS, ALICE C (RPH)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:KOOS
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 1:255 EAST VAN FLEET
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830
Mailing Address - Country:US
Mailing Address - Phone:863-534-1824
Mailing Address - Fax:863-534-3151
Practice Address - Street 1:255 E VAN FLEET DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3831
Practice Address - Country:US
Practice Address - Phone:863-534-1824
Practice Address - Fax:863-534-3151
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist