Provider Demographics
NPI:1891349502
Name:CONKLIN, BRUCE DENNIS JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DENNIS
Last Name:CONKLIN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5916
Mailing Address - Country:US
Mailing Address - Phone:410-933-7600
Mailing Address - Fax:
Practice Address - Street 1:4920 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5916
Practice Address - Country:US
Practice Address - Phone:410-933-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist