Provider Demographics
NPI:1851637805
Name:CONNOR, KIMBERLY RILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RILEY
Last Name: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 1:2100 N ORANGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5516
Mailing Address - Country:US
Mailing Address - Phone:407-897-5292
Mailing Address - Fax:407-897-6635
Practice Address - Street 1:2100 N ORANGE AVE
Practice Address - Street 2:B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5516
Practice Address - Country:US
Practice Address - Phone:407-897-5292
Practice Address - Fax:407-897-6635
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist