Peter X Konicki, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PP410933L Issued in PA

Practice address

278 Main St
Dupont, PA 18641-1960

Phone

(570) 655-8610

Fax

(570) 883-0488

NPI assigned

May 5, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

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.

• Wishbone Enterprises LLC

  dba Konicki Pharmacy

  • Community/Retail Pharmacy
  • Dupont, PA
  • NPI 1497846000
  NPD (past) Authorized official
• Wishbone Enterprises LLC

  dba Winola Pharmacy

  • Community/Retail Pharmacy
  • Lake Winola, PA
  • NPI 1699781492

  Pharmacist

  NPD (past) Authorized official

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

{
    "created_epoch": "1241481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241481600000",
    "number": "1992939920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "278 MAIN STREET",
            "city": "DUPONT",
            "state": "PA",
            "postal_code": "186410000",
            "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": {
        "last_name": "KONICKI",
        "first_name": "PETER",
        "middle_name": "X",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-05",
        "last_updated": "2009-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "PP410933L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100744051002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP/NCPDP",
            "identifier": "3962331",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nestor Garcia Dequevedo, D.C.
• Adam Christopher Hook
• Brian Shawn Jones, PT
• Brianna Ketcho, PTA
• John P Konicki, DDS
• Catherine M Madsen, RD
• Tracy Ann Mooney Wynder, RN
• Tyler James Motisko, DC
• Paul M Rutkowski DO PC
• Redicka Pharmacy

• Pharmacist in Dupont, PA
• Providers in Dupont, PA by specialty
• Pharmacist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2009; 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.