Provider Demographics
NPI:1336779842
Name:MCCONNELL, LAUREN CERY
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CERY
Last Name:MCCONNELL
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 1:2004 WEAVER WAY
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-7586
Mailing Address - Country:US
Mailing Address - Phone:256-997-7265
Mailing Address - Fax:
Practice Address - Street 1:2004 WEAVER WAY
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-7586
Practice Address - Country:US
Practice Address - Phone:256-997-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-100760183500000X
TN46788183500000X
ALS12696390200000X
AL22666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program