Provider Demographics
NPI:1558542324
Name:CONNELLY, THOMAS P
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 UPPER GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2014
Mailing Address - Country:US
Mailing Address - Phone:518-798-0622
Mailing Address - Fax:518-798-0623
Practice Address - Street 1:677 UPPER GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12804-2014
Practice Address - Country:US
Practice Address - Phone:518-798-0622
Practice Address - Fax:518-798-0623
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist