Healthcare Provider Details

I. General information

NPI: 1073752291
Provider Name (Legal Business Name): CONRAD WILLIAM BEELER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 JENNER DR
ALLEGAN MI
49010-1517
US

IV. Provider business mailing address

12920 MARSH RD
SHELBYVILLE MI
49344
US

V. Phone/Fax

Practice location:
  • Phone: 269-673-2181
  • Fax:
Mailing address:
  • Phone: 269-672-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302021423
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number718
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: