Provider Demographics
NPI:1538358031
Name:CONLEY, DANETTE (PHARM D)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:INA
Other - Middle Name:DANETTE
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823-1910
Mailing Address - Country:US
Mailing Address - Phone:606-589-2234
Mailing Address - Fax:606-589-4610
Practice Address - Street 1:2307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-1910
Practice Address - Country:US
Practice Address - Phone:606-589-2234
Practice Address - Fax:606-589-4610
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist