Provider Demographics
NPI:1821340233
Name:KONOPKO, MARTIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:KONOPKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WILLINGLAKES CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:203-435-8579
Mailing Address - Fax:
Practice Address - Street 1:703 GREENVILLE BLVD SE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5103
Practice Address - Country:US
Practice Address - Phone:252-756-1993
Practice Address - Fax:252-756-1385
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21527OtherNC PHARMACIST LICENSE