Provider Demographics
NPI:1912182056
Name:KONKOL, JACQUELINE ALICE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ALICE
Last Name:KONKOL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ALICE
Other - Last Name:MATIKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:657 BROADWAY
Mailing Address - Street 2:RITE AID #1302
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-561-1090
Mailing Address - Fax:845-863-0244
Practice Address - Street 1:657 BROADWAY
Practice Address - Street 2:RITE AID #1302
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-1090
Practice Address - Fax:845-863-0244
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist