Provider Demographics
NPI:1528192739
Name:BARKER, CONNIE JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JEAN
Last Name:BARKER
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 1:4454 CARRIAGE CIR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9511
Mailing Address - Country:US
Mailing Address - Phone:315-469-4081
Mailing Address - Fax:315-443-7981
Practice Address - Street 1:111 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-0001
Practice Address - Country:US
Practice Address - Phone:315-443-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035712-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist