| NPI | 1033154273 |
|---|---|
| Doing Business As | JAN S CONNELLY MD |
| Entity Type | Organization |
| Authorized Contact | DIRENDIA SHACKELFORD Managed Care Specialist 800-654-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: WA MD00019284) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2020-08-22 |