WISHBONE ENTERPRISES LLC (NPI# 1497846000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497846000 |
| Entity Type | Organization |
| Organization Name | WISHBONE ENTERPRISES LLC |
| Other Organization Name | KONICKI PHARMACY |
| Practice Address |
278 Main St Dupont PA 18641-1960 |
| Practice Telephone | 5706558610 |
| Practice Fax Number | 5708830488 |
| Mailing Telephone | 5706558610 |
| Mailing Fax Number | 5708830488 |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2010-08-16 |
| Authorized Official Name | PETER KONICKI (PRESIDENT) |
| Authorized Official Telephone | 5706558610 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PP410933L | PA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 3946893 | 01 | |
| PA | 1007440510002 | 05 |
| Other Name | Type Code |
|---|---|
| Konicki Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699781492 | Wishbone Enterprises LLC | Pharmacist | Route 307 Winola Plaza, Lake Winola, PA 18625-2962 | 2006-08-01 |
| Street Address |
278 MAIN ST |
| City | DUPONT |
| State | PA |
| Zip Code | 18641-1960 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992939920 | Peter X Konicki | Pharmacist | 278 Main St, Dupont, PA 18641-1960 | 2009-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245724970 | Adam Christopher Hook | Dietitian, Registered | 216 Center St, Dupont, PA 18641 | 2018-06-16 |
| 1932430998 | Llewellyn's Ltc | Durable Medical Equipment & Medical Supplies | 703b Main St, Avoca, PA 18641 | 2010-01-14 |
| 1811122237 | Jennifer Culp | Speech-Language Pathologist | 604 South St, Avoca, PA 18641 | 2009-05-29 |
| 1467523803 | Peter J Loiacono | Dentist | 180 South Main St, Avoca, PA 18641 | 2006-11-09 |
| 1760592430 | John P Konicki | Dentist | 278 Main Street, Suite 101, Dupont, PA 18641 | 2006-08-30 |
| 1750875241 | Altitude Nutrition and Exercise Consulting LLC | Dietitian, Registered | 216 Center St, Dupont, PA 18641 | 2018-06-18 |
| 1063855237 | Deborah L Khalife | Physician Assistant | 824 Mcalpine St, Avoca, PA 18641 | 2013-04-08 |
| 1922377886 | Llewellyns Inc | Durable Medical Equipment & Medical Supplies | 703 Main St, Avoca, PA 18641 | 2011-12-22 |
| 1164433199 | George Richard Stanis | Dentist | 1305 Main St, Avoca, PA 18641 | 2006-08-11 |
| 1972707016 | Dequevedo Chiropractic | Chiropractor | Po Box 5172, Avoca, PA 18641-0172 | 2007-06-13 |
| Find all providers in zip 18641 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1699387779 | Allegheny Valley Hospital Retail Pharmacy | Pharmacy | 1301 Carlisle St Fl 3, Natrona Heights, PA 15065-1152 | 2020-08-19 |
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| 1184241408 | Roosevelt Pharmacy LLC | Pharmacy | 2600 Cottman Ave, Philadelphia, PA 19149-1301 | 2020-07-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.