Healthcare Provider Details

I. General information

NPI: 1891620100
Provider Name (Legal Business Name): KENNETH CONNELLY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2897
US

IV. Provider business mailing address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2897
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6000
  • Fax:
Mailing address:
  • Phone: 718-206-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number042439-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: