Provider Demographics
NPI:1952870966
Name:KOONS, GEORGE D (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:KOONS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 JAMES RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7048
Mailing Address - Country:US
Mailing Address - Phone:570-522-8182
Mailing Address - Fax:
Practice Address - Street 1:6901 WESTBRANCH HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6353
Practice Address - Country:US
Practice Address - Phone:570-524-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP1004981183500000X
PARP025634L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist