Provider Demographics
NPI:1376837906
Name:KONKLER, STEPHENIE
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:
Last Name:KONKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 UNIVERSITY PARKWAY
Mailing Address - Street 2:T1077
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105
Mailing Address - Country:US
Mailing Address - Phone:336-744-2580
Mailing Address - Fax:
Practice Address - Street 1:5420 UNIVERSITY PARKWAY
Practice Address - Street 2:T1077
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1366
Practice Address - Country:US
Practice Address - Phone:336-744-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist