Healthcare Provider Details

I. General information

NPI: 1013039353
Provider Name (Legal Business Name): THOMAS G MCCONNELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CEDAR
KUTTAWA KY
42055
US

IV. Provider business mailing address

328 CHAMPION HILLS RD 18 C
KUTTAWA KY
42055-6808
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-7371
  • Fax:
Mailing address:
  • Phone: 270-388-2654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007462
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: