Provider Demographics
NPI:1740572767
Name:CONGER, JOHN STEVEN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:CONGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HWY 52 BYPASS W
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083
Mailing Address - Country:US
Mailing Address - Phone:615-666-3613
Mailing Address - Fax:615-666-2684
Practice Address - Street 1:320 HWY 52 BYPASS W
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083
Practice Address - Country:US
Practice Address - Phone:615-666-3613
Practice Address - Fax:615-666-2684
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist