Provider Demographics
NPI:1659660561
Name:MCCONNELL, ALBERT THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:THOMAS
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 1:113 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-0967
Mailing Address - Country:US
Mailing Address - Phone:276-496-5289
Mailing Address - Fax:276-496-0233
Practice Address - Street 1:113 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370
Practice Address - Country:US
Practice Address - Phone:276-496-5289
Practice Address - Fax:276-496-0233
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00202005956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist