Provider Demographics
NPI:1518749134
Name:CONNER, DEBRA JANE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANE
Last Name:CONNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 N ROCKY TOP RD
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-8101
Mailing Address - Country:US
Mailing Address - Phone:417-724-5350
Mailing Address - Fax:
Practice Address - Street 1:1235 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2203
Practice Address - Country:US
Practice Address - Phone:417-496-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist