Organization
WISHBONE ENTERPRISES LLC
Active
Other names
Konicki Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PETER KONICKI (PRESIDENT)
(570) 655-8610
Entity
Organization
Contact information
Practice address
278 MAIN ST, DUPONT, PA 18641-1960
(570) 655-8610
(570) 883-0488
Mailing address
278 MAIN ST, DUPONT, PA 18641-1960
(570) 655-8610
(570) 883-0488
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP410933L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007440510002
—
PA
01
—
3946893
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/27/2006
Last updated
08/16/2010
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