Healthcare Provider Details

I. General information

NPI: 1043314594
Provider Name (Legal Business Name): KEITH THOMAS DONNELLY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 9D
CASTLE POINT NY
12511
US

IV. Provider business mailing address

13 ROSE HILL PARK
CORNWALL NY
12518-1423
US

V. Phone/Fax

Practice location:
  • Phone: 845-831-2000
  • Fax: 845-838-5189
Mailing address:
  • Phone: 845-831-2000
  • Fax: 845-838-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: