Healthcare Provider Details

I. General information

NPI: 1912288929
Provider Name (Legal Business Name): MICHAEL WILLIAM MCCONNELL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W MARKET ST
AKRON OH
44313-6911
US

IV. Provider business mailing address

1193 WILLOW BEND DR
MEDINA OH
44256-4129
US

V. Phone/Fax

Practice location:
  • Phone: 330-869-2097
  • Fax:
Mailing address:
  • Phone: 330-321-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-11603
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: