Provider Demographics
NPI:1720861586
Name:CONKRIGHT, HANNAH MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MAE
Last Name:CONKRIGHT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MAE
Other - Last Name:KOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:365 E HIGHWAY 106
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:IL
Mailing Address - Zip Code:62343-1040
Mailing Address - Country:US
Mailing Address - Phone:217-506-2008
Mailing Address - Fax:
Practice Address - Street 1:436 N 30TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3602
Practice Address - Country:US
Practice Address - Phone:217-224-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP107421835P0018X
IL051.306312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist