Healthcare Provider Details

I. General information

NPI: 1164604583
Provider Name (Legal Business Name): FRANK BERNARD KORONKIEWICZ R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 ALDERMAN DR NW
ALBUQUERQUE NM
87120-5405
US

IV. Provider business mailing address

6121 ALDERMAN DR NW
ALBUQUERQUE NM
87120-5405
US

V. Phone/Fax

Practice location:
  • Phone: 570-954-1117
  • Fax:
Mailing address:
  • Phone: 570-954-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00007972
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033609L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: