Provider Demographics
NPI:1316547631
Name:CONNOR, TINA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:CONNOR
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 1:188 PAUL SHORT RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15849-2414
Mailing Address - Country:US
Mailing Address - Phone:814-594-0761
Mailing Address - Fax:
Practice Address - Street 1:100 SUPERCENTER DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-6027
Practice Address - Country:US
Practice Address - Phone:814-765-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist