Provider Demographics
NPI:1205286531
Name:CONLEY, IKUKO (RPH)
Entity type:Individual
Prefix:MRS
First Name:IKUKO
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1485
Mailing Address - Country:US
Mailing Address - Phone:419-339-7551
Mailing Address - Fax:
Practice Address - Street 1:730 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4602
Practice Address - Country:US
Practice Address - Phone:419-226-9025
Practice Address - Fax:419-226-9388
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03115066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist