Provider Demographics
NPI:1992225445
Name:CONRAD, AMBER M (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1029
Mailing Address - Country:US
Mailing Address - Phone:304-845-0390
Mailing Address - Fax:304-845-0391
Practice Address - Street 1:118 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1029
Practice Address - Country:US
Practice Address - Phone:304-845-0390
Practice Address - Fax:304-845-0391
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist