Healthcare Provider Details

I. General information

NPI: 1437959400
Provider Name (Legal Business Name): CONNEE BROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 SW 32ND AVE
OCALA FL
34474-4445
US

IV. Provider business mailing address

9178 SW 57TH PLACE RD
OCALA FL
34481-2706
US

V. Phone/Fax

Practice location:
  • Phone: 352-547-1915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: