Provider Demographics
NPI:1770233686
Name:CONNOLLY, TIMOTHY POON (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:POON
Last Name:CONNOLLY
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 1:800 ALTA ST SW APT B203
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6095
Mailing Address - Country:US
Mailing Address - Phone:845-399-5848
Mailing Address - Fax:
Practice Address - Street 1:2828 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3513
Practice Address - Country:US
Practice Address - Phone:360-223-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61076582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist