Provider Demographics
NPI:1124252812
Name:KONECNY, CHERYL A (RPH)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:KONECNY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 DEVILS HOLE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-9647
Mailing Address - Country:US
Mailing Address - Phone:419-849-3132
Mailing Address - Fax:
Practice Address - Street 1:722 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3830
Practice Address - Country:US
Practice Address - Phone:419-354-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist