Provider Demographics
NPI:1972716587
Name:KONYCKI, ANN ADORA
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ADORA
Last Name:KONYCKI
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 1:236 SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-3643
Mailing Address - Country:US
Mailing Address - Phone:570-256-3196
Mailing Address - Fax:
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1607
Practice Address - Country:US
Practice Address - Phone:570-735-4324
Practice Address - Fax:570-735-0378
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028597L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist