Provider Demographics
NPI:1184648446
Name:CONNOLLY, ANNA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:M
Last Name:CONNOLLY
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 1:165 KIMEL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6945
Mailing Address - Country:US
Mailing Address - Phone:336-821-7060
Mailing Address - Fax:888-383-0267
Practice Address - Street 1:165 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6945
Practice Address - Country:US
Practice Address - Phone:336-821-7060
Practice Address - Fax:888-383-0267
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006897183500000X
NC7002921835P2201X
NC282721835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist