Healthcare Provider Details

I. General information

NPI: 1619596046
Provider Name (Legal Business Name): CONNIE J PLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HILL ST
DUBUQUE IA
52001-6678
US

IV. Provider business mailing address

535 HILL ST
DUBUQUE IA
52001-6678
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-4033
  • Fax:
Mailing address:
  • Phone: 563-588-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17475
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: