Provider Demographics
NPI:1366717266
Name:KONAN, GREGORY JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:KONAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ROUND RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-9201
Mailing Address - Country:US
Mailing Address - Phone:717-585-1706
Mailing Address - Fax:
Practice Address - Street 1:5125 JONESTOWN RD STE 221
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2983
Practice Address - Country:US
Practice Address - Phone:717-412-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045427R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist