Provider Demographics
NPI:1619630886
Name:MCCONNELL, JUSTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:M
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 1:6850 SHARLANDS AVE UNIT C1010
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2750
Mailing Address - Country:US
Mailing Address - Phone:530-310-5032
Mailing Address - Fax:
Practice Address - Street 1:2890 NORTHTOWNE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-2178
Practice Address - Country:US
Practice Address - Phone:775-358-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist