Provider Demographics
NPI:1689273757
Name:CONLEY, JORDAN (RPH, LDE)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:RPH, LDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 MUD LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2870
Mailing Address - Country:US
Mailing Address - Phone:502-962-8022
Mailing Address - Fax:502-962-9216
Practice Address - Street 1:5001 MUD LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2870
Practice Address - Country:US
Practice Address - Phone:502-962-8022
Practice Address - Fax:502-962-9216
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021318A1835P0018X
KY126321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist