Provider Demographics
NPI:1902385529
Name:O'CONNELL, REBECCA BLUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BLUE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BLUE
Other - Last Name:BASLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7839 SW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5791
Mailing Address - Country:US
Mailing Address - Phone:305-393-9495
Mailing Address - Fax:386-719-5456
Practice Address - Street 1:255 NW COMMONS LOOP
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-7700
Practice Address - Country:US
Practice Address - Phone:386-719-5451
Practice Address - Fax:386-719-5456
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS58191OtherSTATE LICENSE