Healthcare Provider Details

I. General information

NPI: 1790943785
Provider Name (Legal Business Name): PATRICIA R CONNOLLY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 TAMIAMI TRL C/O WALGREENS
PORT CHARLOTTE FL
33952-6601
US

IV. Provider business mailing address

3001 TAMIAMI TRL
PORT CHARLOTTE FL
33952-6601
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-6399
  • Fax:
Mailing address:
  • Phone: 941-235-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: