MEDICARE: DR. KRISTA LEE KONAPELSKY

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
1	183500000X	Pharmacist	18730	MD

General Provider Information

NPI Number	:	1720399611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTA LEE KONAPELSKY

Provider Business Mailing Address
First Line	:	7582 MAIDEN HEAD DR
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1924
Country	:	US
Telephone Number	:	410-799-1964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 BAY RIDGE AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-3031
Country	:	US
Telephone Number	:	410-267-8600
Fax Number	:	410-267-0914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/25/2010

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