Provider Demographics
NPI:1740491695
Name:CONARD, JANE LEE (RPH)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:LEE
Last Name:CONARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 BLUE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8149
Mailing Address - Country:US
Mailing Address - Phone:231-223-4467
Mailing Address - Fax:
Practice Address - Street 1:MUNSON MEDICAL CENTER
Practice Address - Street 2:1105 SIXTH ST
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5032032876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist