MEDICARE: MRS. SHANNON CONRAD RPN

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	183500000X	Pharmacist	03122277	OH

General Provider Information

NPI Number	:	1215213491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON CONRAD RPN

Provider Business Mailing Address
First Line	:	751 RICHMOND RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2917
Country	:	US
Telephone Number	:	440-442-3368
Fax Number	:	440-442-3462

Provider Business Practice Location Address
First Line	:	751 RICHMOND RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2917
Country	:	US
Telephone Number	:	440-442-3368
Fax Number	:	440-442-3462

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

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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