Provider Demographics
NPI:1730483751
Name:POUNCEY, CONNIE BURT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:BURT
Last Name:POUNCEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:LOUISE
Other - Last Name:BURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2140 UPPER WETUMPKA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-1342
Mailing Address - Country:US
Mailing Address - Phone:334-262-0363
Mailing Address - Fax:334-834-4562
Practice Address - Street 1:2140 UPPER WETUMPKA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-1342
Practice Address - Country:US
Practice Address - Phone:334-262-0363
Practice Address - Fax:334-834-4562
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist