Provider Demographics
NPI:1407178213
Name:CONN, GARY ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLEN
Last Name:CONN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2520 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3384
Mailing Address - Country:US
Mailing Address - Phone:859-278-6029
Mailing Address - Fax:859-276-0269
Practice Address - Street 1:2520 NICHOLASVILLE RD
Practice Address - Street 2:SUITE #10
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3384
Practice Address - Country:US
Practice Address - Phone:859-278-6029
Practice Address - Fax:859-276-0269
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist