Organization
WISHBONE ENTERPRISES LLC
Active
Other names
Winola Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER X KONICKI RPH (PHARMACY OWNER)
(570) 378-2885
Entity
Organization
Contact information
Practice address
ROUTE 307 WINOLA PLAZA, LAKE WINOLA, PA 18625-2962
(570) 378-2885
(570) 378-2962
Mailing address
PO BOX 279, LAKE WINOLA, PA 18625-0279
(570) 378-2885
(570) 378-2962
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PP414435L
PA
332B00000X
Durable Medical Equipment & Medical Supplies
RP032206L
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP414435L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007440510001
—
PA
01
—
3962330
NABP
PA
Enumeration date
08/01/2006
Last updated
05/15/2012
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