Provider Demographics
NPI:1356124051
Name:CONNELL, TIMOTHY JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:CONNELL
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:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:ORICK
Mailing Address - State:CA
Mailing Address - Zip Code:95555-0031
Mailing Address - Country:US
Mailing Address - Phone:707-951-3080
Mailing Address - Fax:707-465-1804
Practice Address - Street 1:575 M ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2827
Practice Address - Country:US
Practice Address - Phone:707-465-3981
Practice Address - Fax:707-465-1804
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist