Provider Demographics
NPI:1255425757
Name:CONRADY, ALAN DUANE (RPH)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DUANE
Last Name:CONRADY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-1613
Mailing Address - Country:US
Mailing Address - Phone:620-577-4221
Mailing Address - Fax:
Practice Address - Street 1:601 W 11TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5025
Practice Address - Country:US
Practice Address - Phone:620-251-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-9865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist