Provider Demographics
NPI:1841573607
Name:CONRAD, ANNE-MARIE M (RPH)
Entity type:Individual
Prefix:MS
First Name:ANNE-MARIE
Middle Name:M
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANNE-MARIE
Other - Middle Name:
Other - Last Name:MISIASZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:177 KNOX TRAIL ROAD
Mailing Address - City:WEST WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01092-0462
Mailing Address - Country:US
Mailing Address - Phone:603-553-1312
Mailing Address - Fax:
Practice Address - Street 1:171 WEST ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1458
Practice Address - Country:US
Practice Address - Phone:413-277-9794
Practice Address - Fax:413-277-9749
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23185183500000X
NH3020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist