Provider Demographics
NPI:1720423544
Name:CONLEY, JESSICA YAX (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:YAX
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389 MAPLE GROVE LN NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4218
Mailing Address - Country:US
Mailing Address - Phone:980-255-8028
Mailing Address - Fax:
Practice Address - Street 1:2389 MAPLE GROVE LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4218
Practice Address - Country:US
Practice Address - Phone:980-255-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist