Provider Demographics
NPI:1053634501
Name:O'CONNOR, MARCIA RUTH (BS,RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:RUTH
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:BS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7-1/2 SOUTH DELAWARE ST.
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-1227
Mailing Address - Country:US
Mailing Address - Phone:607-434-5087
Mailing Address - Fax:
Practice Address - Street 1:7 1/2 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1227
Practice Address - Country:US
Practice Address - Phone:607-434-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029396OtherLICENSE