Provider Demographics
NPI:1861733107
Name:CONNELL, NATALIE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:CONNELL
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 1:50 CREWS CANYON LN
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939
Mailing Address - Country:US
Mailing Address - Phone:618-922-8998
Mailing Address - Fax:
Practice Address - Street 1:110 W 10TH ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1502
Practice Address - Country:US
Practice Address - Phone:618-524-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist