=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083127401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA JEAN CONNORS RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2017
-----------------------------------------------------
Last Update Date | 11/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 828 NEWVILLE RD
-----------------------------------------------------
City | ORLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95963-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-865-9859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 SHERIDAN AVE APT 32
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95926-2745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-733-0378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 76105
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------