Provider Demographics
NPI:1255678827
Name:GARRELTS, CONNIE JEAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:JEAN
Last Name:GARRELTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 MCGREGOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3417
Mailing Address - Country:US
Mailing Address - Phone:239-332-4881
Mailing Address - Fax:239-332-4468
Practice Address - Street 1:2160 MCGREGOR BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3417
Practice Address - Country:US
Practice Address - Phone:239-332-4881
Practice Address - Fax:239-332-4468
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist