Provider Demographics
NPI:1386418275
Name:MCCONNELL, ELLEN A (PHARMD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:A
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:A
Other - Last Name:BERNHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:519 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HAXTUN
Mailing Address - State:CO
Mailing Address - Zip Code:80731-2755
Mailing Address - Country:US
Mailing Address - Phone:970-520-8116
Mailing Address - Fax:
Practice Address - Street 1:235 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:HAXTUN
Practice Address - State:CO
Practice Address - Zip Code:80731-2737
Practice Address - Country:US
Practice Address - Phone:970-774-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist