Provider Demographics
NPI:1679862478
Name:CONLEY, STACIA RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACIA
Middle Name:RENEE
Last Name:CONLEY
Suffix:
Gender:F
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:KY
Mailing Address - Zip Code:41630-0606
Mailing Address - Country:US
Mailing Address - Phone:606-946-2015
Mailing Address - Fax:
Practice Address - Street 1:262 KY RT 122
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41630
Practice Address - Country:US
Practice Address - Phone:606-285-9908
Practice Address - Fax:606-285-9807
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist