Provider Demographics
NPI:1053911024
Name:MCCONNELL, BETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:MCCONNELL
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 1:1874 BOONES PATH RD
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24281-8825
Mailing Address - Country:US
Mailing Address - Phone:423-526-9104
Mailing Address - Fax:
Practice Address - Street 1:1255 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1896
Practice Address - Country:US
Practice Address - Phone:606-248-6288
Practice Address - Fax:606-248-8514
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist