Provider Demographics
NPI:1306327192
Name:MACK, CONNOR JAMES MARIO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:JAMES MARIO
Last Name:MACK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7211
Mailing Address - Country:US
Mailing Address - Phone:607-743-7242
Mailing Address - Fax:
Practice Address - Street 1:119 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:NY
Practice Address - Zip Code:13783-1017
Practice Address - Country:US
Practice Address - Phone:607-638-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0643301835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty