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General NPI Number Information
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NPI Number | 1144530080
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE CONNELL CPHT
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Gender | Female
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 440 W GULF ATLANTIC HWY
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City | WILDWOOD
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State | FL
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Zip | 34785-7301
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Country | US
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Telephone | 352-330-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 10367 E ROO LN PO BOX 651
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City | FLORAL CITY
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State | FL
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Zip | 34436-2957
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Country | US
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Telephone | 352-727-0382
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Fax | 352-330-0673
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | RPT 430
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License Number State | FL
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