Provider Demographics
NPI:1982206629
Name:HURST, CONNIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ELIZABETH
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-2541
Mailing Address - Country:US
Mailing Address - Phone:850-526-5766
Mailing Address - Fax:
Practice Address - Street 1:2255 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-2541
Practice Address - Country:US
Practice Address - Phone:850-526-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist