Healthcare Provider Details

I. General information

NPI: 1487802104
Provider Name (Legal Business Name): ALAN J KONNER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 09/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 NEW PALTZ PLZ
NEW PALTZ NY
12561-1616
US

IV. Provider business mailing address

26 NEW PALTZ PLZ
NEW PALTZ NY
12561-1616
US

V. Phone/Fax

Practice location:
  • Phone: 845-255-3344
  • Fax: 845-255-8985
Mailing address:
  • Phone: 845-255-3344
  • Fax: 845-255-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: