Provider Demographics
NPI:1689497042
Name:CONNOLLY, VANESSA (PHARMD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:CONNOLLY
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 1:537 FLOUR MILL DR
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-9652
Mailing Address - Country:US
Mailing Address - Phone:209-535-7449
Mailing Address - Fax:
Practice Address - Street 1:397 5TH ST
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:CA
Practice Address - Zip Code:95322-1236
Practice Address - Country:US
Practice Address - Phone:208-854-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH89697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist