Provider Demographics
NPI:1912943473
Name:CONGER, MICHAEL ELLIOT (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELLIOT
Last Name:CONGER
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 1:790 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1408
Mailing Address - Country:US
Mailing Address - Phone:435-245-6422
Mailing Address - Fax:435-245-5306
Practice Address - Street 1:790 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1408
Practice Address - Country:US
Practice Address - Phone:435-245-6422
Practice Address - Fax:435-245-5306
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5573248-1703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist