Provider Demographics
NPI:1073748091
Name:CONN, SYLVIA JUANITA-IRENE (RPH)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JUANITA-IRENE
Last Name:CONN
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 1:6468 FAY RD
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9140
Mailing Address - Country:US
Mailing Address - Phone:734-587-7262
Mailing Address - Fax:
Practice Address - Street 1:1900 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1008
Practice Address - Country:US
Practice Address - Phone:313-892-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist