Provider Demographics
NPI:1679856587
Name:COX, CONRAD PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:PAUL
Last Name:COX
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 1:409 PLATER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5615
Mailing Address - Country:US
Mailing Address - Phone:985-447-5881
Mailing Address - Fax:985-448-0917
Practice Address - Street 1:201 N CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2910
Practice Address - Country:US
Practice Address - Phone:985-446-5646
Practice Address - Fax:985-448-0917
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist