Healthcare Provider Details

I. General information

NPI: 1649578584
Provider Name (Legal Business Name): MARK THOMPSON CONRADI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9081 AL HIGHWAY 22
MAPLESVILLE AL
36750-3221
US

IV. Provider business mailing address

PO BOX 145
MAPLESVILLE AL
36750-0145
US

V. Phone/Fax

Practice location:
  • Phone: 334-366-2425
  • Fax: 334-366-2456
Mailing address:
  • Phone: 334-366-2425
  • Fax: 334-366-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7706
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: