Active NPI
Kenneth Kondracki
- Pharmacist
- Berwyn, PA
National Provider Identifier
1750559050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP033605L
- Practice address
- 450 MW Swedesford Rd
Berwyn, PA 19312 - Phone
- (610) 647-8031
- NPI assigned
- Feb 20, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP033605L | PA | Primary |
Addresses
Primary practice location
450 MW Swedesford Rd
Berwyn, PA 19312
Mailing address
122 Hibernia Rd
Coatesville, PA 19320-1380
Phone (610) 647-8031
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RP033605L | Other | PA | PHARMACIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP033605L | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Super Fresh Food Markets Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Ocean City, NJ
- NPI 1114942778
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203465600000",
"number": "1750559050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 HIBERNIA RD",
"city": "COATESVILLE",
"state": "PA",
"postal_code": "193201380",
"telephone_number": "610-647-8031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 MW SWEDESFORD RD",
"city": "BERWYN",
"state": "PA",
"postal_code": "19312",
"telephone_number": "610-647-8031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONDRACKI",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-20",
"last_updated": "2008-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP033605L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "RP033605L",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.