Provider Demographics
NPI:1326709429
Name:CONNELLY, ARIEL DOMINIQUE (RPH)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:DOMINIQUE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4862
Mailing Address - Country:US
Mailing Address - Phone:216-271-0970
Mailing Address - Fax:
Practice Address - Street 1:6301 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4862
Practice Address - Country:US
Practice Address - Phone:216-271-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist