Provider Demographics
NPI:1417499922
Name:KORNECKI, PATRYK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRYK
Middle Name:
Last Name:KORNECKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5410
Mailing Address - Country:US
Mailing Address - Phone:617-232-7506
Mailing Address - Fax:617-232-7519
Practice Address - Street 1:429 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5410
Practice Address - Country:US
Practice Address - Phone:617-232-7506
Practice Address - Fax:617-232-7519
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist