Healthcare Provider Details

I. General information

NPI: 1285243220
Provider Name (Legal Business Name): JONATHAN MICHAEL KONKOL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 COTTAGE GROVE RD
MADISON WI
53718-1300
US

IV. Provider business mailing address

205 N SEGOE RD APT 411
MADISON WI
53705-4914
US

V. Phone/Fax

Practice location:
  • Phone: 608-223-0951
  • Fax: 608-223-0976
Mailing address:
  • Phone: 608-234-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number20369
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: