MEDICARE: JESSICA YAX CONLEY PHARMD

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	23092	NC

General Provider Information

NPI Number	:	1720423544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA YAX CONLEY PHARMD

Provider Business Mailing Address
First Line	:	2389 MAPLE GROVE LN NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4218
Country	:	US
Telephone Number	:	980-255-8028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2389 MAPLE GROVE LN NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4218
Country	:	US
Telephone Number	:	980-255-8028
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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