Provider Demographics
NPI:1821215401
Name:O'CONNELL, ALISSA L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:L
Last Name:O'CONNELL
Suffix:
Gender:F
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 1:8412 6TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-1789
Mailing Address - Country:US
Mailing Address - Phone:425-335-4935
Mailing Address - Fax:
Practice Address - Street 1:205 PINE AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2539
Practice Address - Country:US
Practice Address - Phone:360-563-0223
Practice Address - Fax:360-563-0418
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00066744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00066744OtherSTATE PHARMACIST LICENSE