Provider Demographics
NPI:1518391895
Name:MCCONNELL, LYNN (RPH)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-8002
Mailing Address - Country:US
Mailing Address - Phone:217-762-3377
Mailing Address - Fax:217-762-4499
Practice Address - Street 1:1402 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-8002
Practice Address - Country:US
Practice Address - Phone:217-762-3377
Practice Address - Fax:217-762-4499
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.031076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist