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General NPI Number Information
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NPI Number | 1952778235
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Entity Type | Individual
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Provider Name | LEVIS MCCONNELL III RPH
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Gender | Male
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 12070 CRABAPPLE RD
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City | ROSWELL
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State | GA
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Zip | 30075-2422
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Country | US
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Telephone | 770-992-5446
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Fax |
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Provider Business Mailing Address
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Address Line | 12070 CRABAPPLE RD
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City | ROSWELL
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State | GA
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Zip | 30075-2422
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Country | US
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Telephone | 770-992-5446
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17493
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License Number State | GA
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