Provider Demographics
NPI:1407182751
Name:CONWAY, KERRY COLLEEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:COLLEEN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23620 N 20TH DR
Mailing Address - Street 2:#12
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0621
Mailing Address - Country:US
Mailing Address - Phone:623-434-3663
Mailing Address - Fax:623-434-3676
Practice Address - Street 1:23620 N 20TH DR
Practice Address - Street 2:#12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0621
Practice Address - Country:US
Practice Address - Phone:623-434-3663
Practice Address - Fax:623-434-3676
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH29284183500000X
AZS011602183500000X
NV17563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist