Provider Demographics
NPI:1174818041
Name:CONWAY, JODY W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:W
Last Name:CONWAY
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 1:5401 W BROAD ST
Mailing Address - Street 2:T1018
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2629
Mailing Address - Country:US
Mailing Address - Phone:804-285-2975
Mailing Address - Fax:804-285-2975
Practice Address - Street 1:5401 W BROAD ST
Practice Address - Street 2:T1018
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2629
Practice Address - Country:US
Practice Address - Phone:804-285-2975
Practice Address - Fax:804-285-2975
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist