Basic Information
Provider Information
NPI: 1366568867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOLTZ
FirstName: JOHN
MiddleName: P
NamePrefix: MR.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 699 E STATE ST
Address2:  
City: SHARON
State: PA
PostalCode: 161462057
CountryCode: US
TelephoneNumber: 7249833817
FaxNumber: 7249833941
Practice Location
Address1: 740 E STATE ST
Address2: PHARMACY
City: SHARON
State: PA
PostalCode: 161463328
CountryCode: US
TelephoneNumber: 7249835640
FaxNumber: 7249833979
Other Information
ProviderEnumerationDate: 03/22/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XRP038972LPAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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