Provider Demographics
NPI:1982797379
Name:CONNELLY, LYNN ELTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ELTON
Last Name:CONNELLY
Suffix:
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 1:184 RUM GULLY LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8483
Mailing Address - Country:US
Mailing Address - Phone:803-345-5345
Mailing Address - Fax:803-796-1519
Practice Address - Street 1:1300 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5914
Practice Address - Country:US
Practice Address - Phone:803-791-7043
Practice Address - Fax:803-796-1519
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist