Healthcare Provider Details

I. General information

NPI: 1841307402
Provider Name (Legal Business Name): FREDERICK JOSEF BONCHOSKY R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 NATIONAL PIKE
HOPWOOD PA
15445
US

IV. Provider business mailing address

205 LEXINGTON PL
UNIONTOWN PA
15401-5621
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-2353
  • Fax: 724-437-8648
Mailing address:
  • Phone: 724-437-2353
  • Fax: 724-437-8648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP027970L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010914
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: