Provider Demographics
NPI:1013339118
Name:O'NEILL, PAUL KELLY (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL KELLY
Middle Name:
Last Name:O'NEILL
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 1:2791 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-4411
Mailing Address - Country:US
Mailing Address - Phone:605-353-9513
Mailing Address - Fax:605-353-9515
Practice Address - Street 1:2791 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4411
Practice Address - Country:US
Practice Address - Phone:605-353-9513
Practice Address - Fax:605-353-9515
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5540183500000X
SDR5306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist