Healthcare Provider Details

I. General information

NPI: 1780867721
Provider Name (Legal Business Name): SUSAN K CONKLIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WEST MAIN ST
MONTOUR FALLS NY
14865
US

IV. Provider business mailing address

320 WEST MAIN ST
MONTOUR FALLS NY
14865
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-7272
  • Fax: 607-535-4079
Mailing address:
  • Phone: 607-535-7272
  • Fax: 607-535-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: