Healthcare Provider Details

I. General information

NPI: 1447293717
Provider Name (Legal Business Name): CONKLING'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E MAIN ST
PANDORA OH
45877-8706
US

IV. Provider business mailing address

112 E MAIN ST P.O. BOX 296
PANDORA OH
45877-8706
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 Number
License Number StateOH

VIII. Authorized Official

Name: MR. GREGORY DALE CONKLING
Title or Position: OWNER
Credential: R.PH.
Phone: 419-384-3303