Provider Demographics
NPI:1205302940
Name:DOOLITTLE, CONNOR STEPHEN (PHARMD)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:STEPHEN
Last Name:DOOLITTLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W 18TH ST # 7233
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7233
Mailing Address - Country:US
Mailing Address - Phone:575-359-7500
Mailing Address - Fax:575-359-7501
Practice Address - Street 1:501 W 18TH ST # 7233
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7233
Practice Address - Country:US
Practice Address - Phone:575-359-7500
Practice Address - Fax:575-359-7501
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist