Provider Demographics
NPI:1659580140
Name:O'CONNELL, ROBERT MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:O'CONNELL
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 1:6 APPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3262
Mailing Address - Country:US
Mailing Address - Phone:603-635-8619
Mailing Address - Fax:603-635-9095
Practice Address - Street 1:6 APPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3262
Practice Address - Country:US
Practice Address - Phone:603-635-8619
Practice Address - Fax:603-635-9095
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18211183500000X
NHR909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist