Provider Demographics
NPI:1871828491
Name:CONALLY, ELITA (RPH)
Entity Type:Individual
Prefix:
First Name:ELITA
Middle Name:
Last Name:CONALLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 INABINET DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-9504
Mailing Address - Country:US
Mailing Address - Phone:803-481-3075
Mailing Address - Fax:
Practice Address - Street 1:1145 INABINET DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-9504
Practice Address - Country:US
Practice Address - Phone:803-481-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-041915L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist