Provider Demographics
NPI:1679755250
Name:KONSUL, JOHN FITZGERALD (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FITZGERALD
Last Name:KONSUL
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 1:320 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1730
Mailing Address - Country:US
Mailing Address - Phone:518-943-3949
Mailing Address - Fax:518-943-9280
Practice Address - Street 1:320 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1730
Practice Address - Country:US
Practice Address - Phone:518-943-3949
Practice Address - Fax:518-943-9280
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01909860Medicaid