Basic Information
| Provider Information | |||||||||
| NPI: | 1760063465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CPHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2132 OLD SNOW HILL RD | ||||||||
| Address2: | |||||||||
| City: | POCOMOKE CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218512734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109579610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5763 LANDON STORE RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218382503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438802129 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2021 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | T18379 | MD | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.