Provider Demographics
NPI:1356884860
Name:CONLEY, COTY (PHARMD)
Entity type:Individual
Prefix:
First Name:COTY
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 1:120 HOMESTEAD ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:TUTOR KEY
Mailing Address - State:KY
Mailing Address - Zip Code:41263-8702
Mailing Address - Country:US
Mailing Address - Phone:606-371-3714
Mailing Address - Fax:
Practice Address - Street 1:5571 COLLINS HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6846
Practice Address - Country:US
Practice Address - Phone:606-639-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist