Healthcare Provider Details

I. General information

NPI: 1013339118
Provider Name (Legal Business Name): PAUL KELLY O'NEILL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 DAKOTA AVE S
HURON SD
57350-4411
US

IV. Provider business mailing address

2791 DAKOTA AVE S
HURON SD
57350-4411
US

V. Phone/Fax

Practice location:
  • Phone: 605-353-9513
  • Fax: 605-353-9515
Mailing address:
  • Phone: 605-353-9513
  • Fax: 605-353-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5540
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR5306
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: