Provider Demographics
NPI:1821371493
Name:CONLEY, TASSIE JO (RPH)
Entity Type:Individual
Prefix:
First Name:TASSIE
Middle Name:JO
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TASSIE
Other - Middle Name:JO
Other - Last Name:SOUHRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:
Practice Address - Street 1:3919 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1349
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6312183500000X
IDP6449183500000X
NJ28RI03420500183500000X
WAPH60165830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist