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General NPI Number Information
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NPI Number | 1962722249
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Entity Type | Individual
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Provider Name | ROGER W CONELY RPH
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Gender | Male
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 2024 W MAIN ST
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City | MESA
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State | AZ
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Zip | 85201-6802
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Country | US
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Telephone | 480-214-0374
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Fax | 480-214-0377
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Provider Business Mailing Address
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Address Line | 2024 W MAIN ST
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City | MESA
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State | AZ
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Zip | 85201-6802
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Country | US
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Telephone | 480-214-0374
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Fax | 480-214-0377
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8591
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15208
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License Number State | CO
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