Provider Demographics
NPI:1316279466
Name:DONNELLY, GEORGE MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TRASK LN
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4006
Mailing Address - Country:US
Mailing Address - Phone:631-587-6931
Mailing Address - Fax:631-543-3365
Practice Address - Street 1:1163 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3001
Practice Address - Country:US
Practice Address - Phone:631-543-3331
Practice Address - Fax:631-543-3365
Is Sole Proprietor?:No
Enumeration Date:2010-01-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist