Basic Information
| Provider Information | |||||||||
| NPI: | 1558980367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONRAD | ||||||||
| FirstName: | KERRI-LYNN | ||||||||
| MiddleName: | AMBER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8455 FENTON ST APT 320 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209105013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316803995 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3300 CRAIN HWY | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207161398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018058853 | ||||||||
| FaxNumber: | 3018052853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2020 | ||||||||
| LastUpdateDate: | 04/11/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH100002067 | DC | N | Pharmacy Service Providers | Pharmacist | 183500000X | 0202214746 | VA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 24637 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.