Provider Demographics
NPI:1053693085
Name:OCONNELL, LIESL (RPH)
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MIDDLE ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2823
Mailing Address - Country:US
Mailing Address - Phone:781-856-9857
Mailing Address - Fax:
Practice Address - Street 1:66 MIDDLE ST UNIT 2
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2823
Practice Address - Country:US
Practice Address - Phone:781-856-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist