Healthcare Provider Details

I. General information

NPI: 1881760635
Provider Name (Legal Business Name): RICHARD LEE CONNORS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CAMINO JOSEFINA
RIO RICO AZ
85648
US

IV. Provider business mailing address

PO BOX 8160
TUMACACORI AZ
85640-8160
US

V. Phone/Fax

Practice location:
  • Phone: 520-404-2716
  • Fax:
Mailing address:
  • Phone: 520-404-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number15023
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: