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General NPI Number Information
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NPI Number | 1821340233
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Entity Type | Individual
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Provider Name | MARTIN KONOPKO R.PH.
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Gender | Male
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 703 GREENVILLE BLVD SE
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City | GREENVILLE
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State | NC
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Zip | 27858-5103
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Country | US
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Telephone | 252-756-1993
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Fax | 252-756-1385
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Provider Business Mailing Address
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Address Line | 818 WILLINGLAKES CT
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City | ORANGEBURG
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State | SC
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Zip | 29118
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Country | US
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Telephone | 203-435-8579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21527
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License Number State | NC
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