Provider Demographics
NPI:1790066207
Name:O'CONNOR, JOANNE ELLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ELLEN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5550
Mailing Address - Country:US
Mailing Address - Phone:219-769-0013
Mailing Address - Fax:
Practice Address - Street 1:10 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5550
Practice Address - Country:US
Practice Address - Phone:219-769-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43311183500000X
IL051-292075183500000X
WAPH60330390183500000X
IN26028103A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist