Provider Demographics
NPI:1932709862
Name:CONRAD, COURTNEY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LYNN
Last Name:CONRAD
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 1:1100 W MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-3412
Mailing Address - Country:US
Mailing Address - Phone:570-274-4106
Mailing Address - Fax:
Practice Address - Street 1:120 AJK BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7491
Practice Address - Country:US
Practice Address - Phone:570-522-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist