Provider Demographics
NPI:1255954590
Name:CONNELLY, THOMAS JAMES JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:CONNELLY
Suffix:JR
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:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-0420
Mailing Address - Country:US
Mailing Address - Phone:410-658-6444
Mailing Address - Fax:410-658-4222
Practice Address - Street 1:1 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-1876
Practice Address - Country:US
Practice Address - Phone:410-658-6444
Practice Address - Fax:410-658-4222
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist