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NPI Code Detail

MEDICARE: MS. LISA ANN CONKLING R.PH

MEDICARE: MS. LISA ANN CONKLING R.PH
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
1183500000XPharmacistC16242IA

General Provider Information

NPI Number : 1760428189
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA ANN CONKLING R.PH
Provider Business Mailing Address
First Line : 407 ROCKVALLEY DR SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-1094
Country : US
Telephone Number : 319-390-3924
Fax Number :
Provider Business Practice Location Address
First Line : 9255 ATLANTIC DR SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-8950
Country : US
Telephone Number : 319-396-1386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 07/08/2007

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Directions to “ MS. LISA ANN CONKLING R.PH” Practice Location

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