Provider Demographics
NPI:1760063465
Name:CONNER, PAMELA (CPHT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 OLD SNOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-2734
Mailing Address - Country:US
Mailing Address - Phone:410-957-9610
Mailing Address - Fax:
Practice Address - Street 1:5763 LANDON STORE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MD
Practice Address - Zip Code:21838-2503
Practice Address - Country:US
Practice Address - Phone:443-880-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT18379183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician