Provider Demographics
NPI:1467015172
Name:CONLEY, DYANA (PHARM D)
Entity Type:Individual
Prefix:
First Name:DYANA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 PIEDMONT AVE NE OFC
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3457
Mailing Address - Country:US
Mailing Address - Phone:708-728-5819
Mailing Address - Fax:
Practice Address - Street 1:396 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3400
Practice Address - Country:US
Practice Address - Phone:708-728-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARHP030214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist