MEDICARE: MAXWELL CONRAD RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03439810	OH

General Provider Information

NPI Number	:	1164030508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL CONRAD RPH

Provider Business Mailing Address
First Line	:	1840 COLUMBUS PIKE
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-2728
Country	:	US
Telephone Number	:	740-363-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 COLUMBUS PIKE
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-2728
Country	:	US
Telephone Number	:	740-363-0035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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