Healthcare Provider Details

I. General information

NPI: 1205448743
Provider Name (Legal Business Name): CLAYTON CONLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N MILLS AVE
ORLANDO FL
32803-1851
US

IV. Provider business mailing address

1701 N MILLS AVE
ORLANDO FL
32803-1851
US

V. Phone/Fax

Practice location:
  • Phone: 407-770-0507
  • Fax: 706-437-7983
Mailing address:
  • Phone: 706-770-0507
  • Fax: 706-437-7983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH030722
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43104
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS60698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: