Healthcare Provider Details

I. General information

NPI: 1427109206
Provider Name (Legal Business Name): CONKLING'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 EAST MAIN STREET
PANDORA OH
45877
US

IV. Provider business mailing address

PO BOX 296
PANDORA OH
45877-0296
US

V. Phone/Fax

Practice location:
  • Phone: 419-384-3303
  • Fax: 419-384-3308
Mailing address:
  • Phone: 419-384-3303
  • Fax: 419-384-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02-0851200
License Number StateOH

VIII. Authorized Official

Name: GREG CONKLING
Title or Position: OWNER
Credential: RPH
Phone: 419-384-3303