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NPI Code Detail

MEDICARE: HEATHER M KONIECZNY

MEDICARE: HEATHER M KONIECZNY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist062195NY

General Provider Information

NPI Number : 1083111272
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER M KONIECZNY
Provider Business Mailing Address
First Line : 2580 E HENRIETTA RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14623-4526
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2580 E HENRIETTA RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14623-4526
Country : US
Telephone Number : 585-321-2581
Fax Number : 585-321-1517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2018
Last Update Date : 04/12/2018

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Directions to “ HEATHER M KONIECZNY ” Practice Location

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