Provider Demographics
NPI:1487255758
Name:KONKLE, AARON MICHAEL
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:KONKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 31
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:OH
Mailing Address - Zip Code:44882
Mailing Address - Country:US
Mailing Address - Phone:419-310-5083
Mailing Address - Fax:
Practice Address - Street 1:2801 STATE ROUTE 18
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-447-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist