Provider Demographics
NPI:1043504897
Name:CONNOLLY, PAUL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VIRGINIA TER
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4929
Mailing Address - Country:US
Mailing Address - Phone:570-760-2148
Mailing Address - Fax:
Practice Address - Street 1:259 DANA ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-2909
Practice Address - Country:US
Practice Address - Phone:570-760-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist