Basic Information
| Provider Information | |||||||||
| NPI: | 1922286566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNERS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 596 US ROUTE 11 | ||||||||
| Address2: | |||||||||
| City: | TULLY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131599410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156968796 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 437 ELECTRONICS PKWY | ||||||||
| Address2: | |||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130886001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154531750 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 050607 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.