Provider Demographics
NPI:1427109206
Name:CONKLING'S PHARMACY
Entity type:Organization
Organization Name:CONKLING'S PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-384-3303
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-0296
Mailing Address - Country:US
Mailing Address - Phone:419-384-3303
Mailing Address - Fax:419-384-3308
Practice Address - Street 1:112 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877
Practice Address - Country:US
Practice Address - Phone:419-384-3303
Practice Address - Fax:419-384-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-08512003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3673743OtherNABP NCPDP NUMBER
OH02-0851200OtherPHARMACY LICENSE