Provider Demographics
NPI:1366788572
Name:OWENS, CONNIE SUSAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SUSAN
Last Name:OWENS
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 1:1575 OLD TROLLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8208
Mailing Address - Country:US
Mailing Address - Phone:843-832-0557
Mailing Address - Fax:843-832-4237
Practice Address - Street 1:1575 OLD TROLLEY RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8208
Practice Address - Country:US
Practice Address - Phone:843-832-0557
Practice Address - Fax:843-832-4237
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist