Provider Demographics
NPI:1043314594
Name:DONNELLY, KEITH THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:THOMAS
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROSE HILL PARK
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1423
Mailing Address - Country:US
Mailing Address - Phone:845-831-2000
Mailing Address - Fax:845-838-5189
Practice Address - Street 1:100 ROUTE 9D
Practice Address - Street 2:
Practice Address - City:CASTLE POINT
Practice Address - State:NY
Practice Address - Zip Code:12511
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:845-838-5189
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist