Provider Demographics
NPI:1154657658
Name:DONNELLY, WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
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 1:4106 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4123
Mailing Address - Country:US
Mailing Address - Phone:718-762-7111
Mailing Address - Fax:
Practice Address - Street 1:4106 162ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4123
Practice Address - Country:US
Practice Address - Phone:718-762-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist