Provider Demographics
NPI:1508103953
Name:CONNER, MICHAEL SHAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:CONNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 TWAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5972
Mailing Address - Country:US
Mailing Address - Phone:559-593-1764
Mailing Address - Fax:
Practice Address - Street 1:695 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0104
Practice Address - Country:US
Practice Address - Phone:559-321-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist