Provider Demographics
NPI:1952778235
Name:MCCONNELL, LEVIS III (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEVIS
Middle Name:
Last Name:MCCONNELL
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12070 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2422
Mailing Address - Country:US
Mailing Address - Phone:770-992-5446
Mailing Address - Fax:
Practice Address - Street 1:12070 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2422
Practice Address - Country:US
Practice Address - Phone:770-992-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist