Provider Demographics
NPI:1740469048
Name:SKELLY, JAMES VINCENT (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VINCENT
Last Name:SKELLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 STATE ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4714
Mailing Address - Country:US
Mailing Address - Phone:518-483-3990
Mailing Address - Fax:518-483-4186
Practice Address - Street 1:3400 STATE ROUTE 11
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-4714
Practice Address - Country:US
Practice Address - Phone:518-483-3990
Practice Address - Fax:518-483-4186
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY034945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00561995Medicaid