Healthcare Provider Details

I. General information

NPI: 1730973306
Provider Name (Legal Business Name): SCOTT J CONKLIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2446
  • Fax:
Mailing address:
  • Phone: 505-609-2446
  • Fax: 505-609-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRP00007141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: