Provider Demographics
NPI:1164604583
Name:KORONKIEWICZ, FRANK BERNARD (RPH)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:BERNARD
Last Name:KORONKIEWICZ
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 1:6121 ALDERMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5405
Mailing Address - Country:US
Mailing Address - Phone:570-954-1117
Mailing Address - Fax:
Practice Address - Street 1:6121 ALDERMAN DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5405
Practice Address - Country:US
Practice Address - Phone:570-954-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00007972183500000X
PARP033609L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist