Provider Demographics
NPI:1922032747
Name:CONRAD, CHERYL L (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:CONRAD
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 1:572 BASKET RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9610
Mailing Address - Country:US
Mailing Address - Phone:585-216-9386
Mailing Address - Fax:
Practice Address - Street 1:1550 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2104
Practice Address - Country:US
Practice Address - Phone:585-922-2394
Practice Address - Fax:585-922-2333
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist