Wishbone Enterprises LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP410933L Issued in PA

Legal business name

WISHBONE ENTERPRISES LLC

Doing business as

Konicki Pharmacy

Practice address

278 Main St
Dupont, PA 18641-1960

Phone

(570) 655-8610

Fax

(570) 883-0488

NPI assigned

Sep 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peter KonickiNPI 1992939920

Title

President

Phone

(570) 655-8610

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Konicki Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter X Konicki, RPH

  • Pharmacist
  • Dupont, PA
  • NPI 1992939920
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1497846000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "278 MAIN ST",
            "city": "DUPONT",
            "state": "PA",
            "postal_code": "186411960",
            "telephone_number": "570-655-8610",
            "fax_number": "570-883-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "278 MAIN ST",
            "city": "DUPONT",
            "state": "PA",
            "postal_code": "186411960",
            "telephone_number": "570-655-8610",
            "fax_number": "570-883-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISHBONE ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "KONICKI",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-655-8610"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP410933L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007440510002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3946893",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Konicki Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Superior Health Services, Inc.
• Corinne Toczylowski
• Cathy Vanhoof, PA
• Gary Weissberger, D.C.
• Wilkes Barre Scranton Chiropractic and Rehabilitation
• Christopher Yonki, DC

• Community/Retail Pharmacy in Dupont, PA
• Providers in Dupont, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.