Provider Demographics
NPI:1447492624
Name:KONECKI, ANGELA DAWN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:KONECKI
Suffix:
Gender:F
Credentials:PHARMD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:MONTEZUMA CREEK CLINIC CHC PHARMACY
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534-0130
Mailing Address - Country:US
Mailing Address - Phone:435-651-3707
Mailing Address - Fax:435-651-3463
Practice Address - Street 1:E HIGHWAY 262
Practice Address - Street 2:MONTEZUMA CREEK CLINIC CHC PHARMACY
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534
Practice Address - Country:US
Practice Address - Phone:435-651-3707
Practice Address - Fax:435-651-3463
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7147485-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist