Healthcare Provider Details

I. General information

NPI: 1760925697
Provider Name (Legal Business Name): LANDON CONRAD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 CONESTOGA DR
SPRINGFIELD IL
62711-7934
US

IV. Provider business mailing address

4102 AMY CT
SPRINGFIELD IL
62711-5709
US

V. Phone/Fax

Practice location:
  • Phone: 217-547-2410
  • Fax:
Mailing address:
  • Phone: 217-801-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051299535
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: