Provider Demographics
NPI:1982986691
Name:CONNOLLY, PATRICK T
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:T
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S SALEM DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3792
Mailing Address - Country:US
Mailing Address - Phone:847-584-0192
Mailing Address - Fax:
Practice Address - Street 1:930 ELK GROVE TOWN CTR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3754
Practice Address - Country:US
Practice Address - Phone:847-439-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist