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General NPI Number Information
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NPI Number | 1609429000
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Entity Type | Individual
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Provider Name | DR. ROBERT CONZELMAN
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Gender | Male
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 3922 WILLIS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4911
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Country | US
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Telephone | 844-690-4462
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Fax |
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Provider Business Mailing Address
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Address Line | 4112 LEO LN
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City | LOUISVILLE
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State | KY
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Zip | 40299-3431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 016626
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License Number State | KY
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