MEDICARE: DR. KELLY MARIE ONEIL PHARM.D., BCPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26331	MA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	I-0521661	NY

General Provider Information

NPI Number	:	1376544700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MARIE ONEIL PHARM.D., BCPS

Provider Business Mailing Address
First Line	:	312 CARROLL CLOSE
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5216
Country	:	US
Telephone Number	:	781-589-6540
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3725
Country	:	US
Telephone Number	:	212-305-7622
Fax Number	:	212-342-3909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/16/2010

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