Provider Demographics
NPI:1770898249
Name:CONNELLY, MEGAN JOHANNA (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JOHANNA
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JOHANNA
Other - Last Name:VOGELAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3540 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5329
Mailing Address - Country:US
Mailing Address - Phone:505-564-3086
Mailing Address - Fax:
Practice Address - Street 1:236 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-1365
Practice Address - Fax:970-728-1366
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007481183500000X
CO19010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist