Healthcare Provider Details

I. General information

NPI: 1053336388
Provider Name (Legal Business Name): COLETTE F CONNOLLY PHARMD, RPH, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE STRATTON VA MEDICAL CENTER (119)
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE STRATTON VA MEDICAL CENTER (119)
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043686
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number043686
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number043686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: