Provider Demographics
NPI:1831792035
Name:KOONTS, MELISSA KIMBERLY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KIMBERLY
Last Name:KOONTS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 RUBY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1853
Mailing Address - Country:US
Mailing Address - Phone:732-666-1586
Mailing Address - Fax:
Practice Address - Street 1:591 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4420
Practice Address - Country:US
Practice Address - Phone:540-373-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist