Provider Demographics
NPI:1932489424
Name:CONROY, SUSAN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:CONROY
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 1:668 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-7416
Mailing Address - Country:US
Mailing Address - Phone:706-595-1667
Mailing Address - Fax:706-595-7323
Practice Address - Street 1:1051 ALDER WAY
Practice Address - Street 2:APT 402
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-9119
Practice Address - Country:US
Practice Address - Phone:574-286-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024645183500000X
IN26013670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist