Provider Demographics
NPI:1992053714
Name:CONNELLY, JANIE LYNN (PHARM D)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:LYNN
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-0917
Mailing Address - Country:US
Mailing Address - Phone:985-774-3368
Mailing Address - Fax:
Practice Address - Street 1:3440 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-674-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019883183500000X
MSE-12671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist