Healthcare Provider Details

I. General information

NPI: 1790066207
Provider Name (Legal Business Name): JOANNE ELLEN O'CONNOR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 81ST AVE
MERRILLVILLE IN
46410-5550
US

IV. Provider business mailing address

10 E 81ST AVE
MERRILLVILLE IN
46410-5550
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-0013
  • Fax:
Mailing address:
  • Phone: 219-769-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43311
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-292075
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60330390
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26028103A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: