Provider Demographics
NPI:1467682476
Name:O'NEILL, KAELY CHARITY
Entity Type:Individual
Prefix:
First Name:KAELY
Middle Name:CHARITY
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HARBORSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4860
Mailing Address - Country:US
Mailing Address - Phone:845-774-5398
Mailing Address - Fax:
Practice Address - Street 1:1 N GALLERIA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-3032
Practice Address - Country:US
Practice Address - Phone:845-692-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist