Provider Demographics
NPI:1063028074
Name:MCCONNELL, DEEPIKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 PEACH TREE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2843
Mailing Address - Country:US
Mailing Address - Phone:608-469-4265
Mailing Address - Fax:
Practice Address - Street 1:2102 PEACH TREE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2843
Practice Address - Country:US
Practice Address - Phone:608-469-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist