Provider Demographics
NPI:1659477982
Name:KIRKCONNELL, AMY L (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:KIRKCONNELL
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 1:4660 S HAGADORN RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5376
Mailing Address - Country:US
Mailing Address - Phone:517-353-3500
Mailing Address - Fax:517-353-3510
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-353-3500
Practice Address - Fax:517-353-3510
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist