Provider Demographics
NPI:1336757319
Name:O'CONNELL, MATTHEW PETER (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PETER
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PARK STREET, LOWER LEVEL
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-688-8456
Mailing Address - Fax:
Practice Address - Street 1:55 PARK STREET, LOWER LEVEL
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-688-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015396183500000X
NY064741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist