Provider Demographics
NPI:1942297072
Name:CONNOLLY, JENNIFER J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:CONNOLLY
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 1:1647 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1218
Mailing Address - Country:US
Mailing Address - Phone:724-869-9925
Mailing Address - Fax:724-869-8731
Practice Address - Street 1:1647 W STATE ST
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1218
Practice Address - Country:US
Practice Address - Phone:724-869-9925
Practice Address - Fax:724-869-8731
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist