Provider Demographics
NPI:1649578584
Name:CONRADI, MARK THOMPSON (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMPSON
Last Name:CONRADI
Suffix:
Gender:M
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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:MAPLESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36750-0145
Mailing Address - Country:US
Mailing Address - Phone:334-366-2425
Mailing Address - Fax:334-366-2456
Practice Address - Street 1:9081 AL HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MAPLESVILLE
Practice Address - State:AL
Practice Address - Zip Code:36750-3221
Practice Address - Country:US
Practice Address - Phone:334-366-2425
Practice Address - Fax:334-366-2456
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist