Provider Demographics
NPI:1346393048
Name:MCCONNELL, VICKI (PHARM D)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 CANTERCLUB TRAIL
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712
Mailing Address - Country:US
Mailing Address - Phone:407-880-5959
Mailing Address - Fax:
Practice Address - Street 1:277 DOUGLAS AVE
Practice Address - Street 2:SUITE 1010
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3300
Practice Address - Country:US
Practice Address - Phone:407-865-5489
Practice Address - Fax:407-670-0430
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30926183500000X
GARPH014796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH014796OtherPHARMACIST LICENSE
FLPS30928OtherPHARMACIST LICENSE