Provider Demographics
NPI:1306440672
Name:CONRAD, NICHOLE (RPH)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15785 SYMPHONY BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4399
Mailing Address - Country:US
Mailing Address - Phone:812-345-5066
Mailing Address - Fax:
Practice Address - Street 1:13098 PUBLISHERS DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8826
Practice Address - Country:US
Practice Address - Phone:317-598-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020754A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist