Healthcare Provider Details

I. General information

NPI: 1760906705
Provider Name (Legal Business Name): JEFFREY CONNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 POLARIS PKWY
COLUMBUS OH
43240-6000
US

IV. Provider business mailing address

1177 POLARIS PKWY
COLUMBUS OH
43240-6000
US

V. Phone/Fax

Practice location:
  • Phone: 614-430-2445
  • Fax:
Mailing address:
  • Phone: 614-430-2445
  • Fax: 614-430-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03225215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: