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Individual
PETER X KONICKI
Active
Individual
PETER X KONICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PP410933L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744051002
—
PA
01
—
3962331
NABP/NCPDP
—
Enumeration date
05/05/2009
Last updated
05/05/2009
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