MEDICARE: ELAINE J CONNOLLY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43365	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164671756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE J CONNOLLY RPH

Provider Business Mailing Address
First Line	:	2450 JERUSALEM AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1827
Country	:	US
Telephone Number	:	516-826-0057
Fax Number	:	516-826-8037

Provider Business Practice Location Address
First Line	:	2450 JERUSALEM AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1827
Country	:	US
Telephone Number	:	516-826-0057
Fax Number	:	516-826-8037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	02/01/2010

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