Basic Information
| Provider Information | |||||||||
| NPI: | 1205448743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONLEY | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 N MILLS AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067700507 | ||||||||
| FaxNumber: | 7064377983 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 N MILLS AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077700507 | ||||||||
| FaxNumber: | 7064377983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2020 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH030722 | GA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 43104 | SC | N | Pharmacy Service Providers | Pharmacist | 183500000X | PS60698 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.