Provider Demographics
NPI:1043069230
Name:CONN, ALEXA JADE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:JADE
Last Name:CONN
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 1:72 VICE LAND RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40374-9424
Mailing Address - Country:US
Mailing Address - Phone:606-336-4737
Mailing Address - Fax:
Practice Address - Street 1:200 WALMART WAY
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-7217
Practice Address - Country:US
Practice Address - Phone:606-784-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY024194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist