Provider Demographics
NPI:1033493259
Name:CONWAY, NATALIE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXIS
Mailing Address - State:IL
Mailing Address - Zip Code:61412-5021
Mailing Address - Country:US
Mailing Address - Phone:309-370-0594
Mailing Address - Fax:
Practice Address - Street 1:1057 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3973
Practice Address - Country:US
Practice Address - Phone:309-341-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist