Provider Demographics
NPI:1205448743
Name:CONLEY, CLAYTON (PHARMD)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:CONLEY
Suffix:
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 1:1701 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1851
Mailing Address - Country:US
Mailing Address - Phone:706-770-0507
Mailing Address - Fax:706-437-7983
Practice Address - Street 1:1701 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1851
Practice Address - Country:US
Practice Address - Phone:407-770-0507
Practice Address - Fax:706-437-7983
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030722183500000X
SC43104183500000X
FLPS60698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist