Provider Demographics
NPI:1215213491
Name:CONRAD, SHANNON (RPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2917
Mailing Address - Country:US
Mailing Address - Phone:440-442-3368
Mailing Address - Fax:440-442-3462
Practice Address - Street 1:751 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2917
Practice Address - Country:US
Practice Address - Phone:440-442-3368
Practice Address - Fax:440-442-3462
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist