Provider Demographics
NPI:1548359862
Name:CONNOLLY, PAUL DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5151 COUNTY ROAD 30
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-3408
Mailing Address - Country:US
Mailing Address - Phone:256-757-7487
Mailing Address - Fax:
Practice Address - Street 1:5151 COUNTY ROAD 30
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-3408
Practice Address - Country:US
Practice Address - Phone:256-757-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist