Healthcare Provider Details

I. General information

NPI: 1386418275
Provider Name (Legal Business Name): ELLEN A MCCONNELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN A BERNHARD PHARMD

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W FLETCHER ST
HAXTUN CO
80731-2737
US

IV. Provider business mailing address

519 W 2ND ST
HAXTUN CO
80731-2755
US

V. Phone/Fax

Practice location:
  • Phone: 970-774-6979
  • Fax:
Mailing address:
  • Phone: 970-520-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24657
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: