Provider Demographics
NPI:1063137289
Name:CONNELLY, SHANNON MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19334 KNOWLTON PKWY APT 201
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-9042
Mailing Address - Country:US
Mailing Address - Phone:440-478-2242
Mailing Address - Fax:
Practice Address - Street 1:19980 W 130TH ST
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-8437
Practice Address - Country:US
Practice Address - Phone:440-572-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist