Provider Demographics
NPI:1588131916
Name:JARRENDT, CONNOR MCCORMICK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:MCCORMICK
Last Name:JARRENDT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2563
Mailing Address - Country:US
Mailing Address - Phone:540-552-3000
Mailing Address - Fax:540-552-3005
Practice Address - Street 1:1403 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2563
Practice Address - Country:US
Practice Address - Phone:540-552-3000
Practice Address - Fax:540-552-3005
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist