Provider Demographics
NPI:1700487121
Name:MCCONKEY, ALEXIS G
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:G
Last Name:MCCONKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 RIVERSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-7207
Mailing Address - Country:US
Mailing Address - Phone:815-802-3166
Mailing Address - Fax:
Practice Address - Street 1:505 RIVERSTONE PKWY
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-7207
Practice Address - Country:US
Practice Address - Phone:815-802-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist