Provider Demographics
NPI:1013039353
Name:MCCONNELL, THOMAS G (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CHAMPION HILLS RD
Mailing Address - Street 2:18 C
Mailing Address - City:KUTTAWA
Mailing Address - State:KY
Mailing Address - Zip Code:42055-6808
Mailing Address - Country:US
Mailing Address - Phone:270-388-2654
Mailing Address - Fax:
Practice Address - Street 1:86 CEDAR
Practice Address - Street 2:
Practice Address - City:KUTTAWA
Practice Address - State:KY
Practice Address - Zip Code:42055
Practice Address - Country:US
Practice Address - Phone:270-388-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist