Healthcare Provider Details

I. General information

NPI: 1033029178
Provider Name (Legal Business Name): CONNER ADRIAN DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5562 E COUNTY ROAD 800 S
MOORESVILLE IN
46158-7715
US

IV. Provider business mailing address

5562 E COUNTY ROAD 800 S
MOORESVILLE IN
46158-7715
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-7100
  • Fax:
Mailing address:
  • Phone: 317-963-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number99134648A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: