Provider Demographics
NPI:1760428189
Name:CONKLING, LISA ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:CONKLING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ROCKVALLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1094
Mailing Address - Country:US
Mailing Address - Phone:319-390-3924
Mailing Address - Fax:
Practice Address - Street 1:9255 ATLANTIC DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-8950
Practice Address - Country:US
Practice Address - Phone:319-396-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC16242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist