Provider Demographics
NPI:1104125053
Name:DEMYAN, GARY M (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:DEMYAN
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 1:1911 ABINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1503
Mailing Address - Country:US
Mailing Address - Phone:610-861-2990
Mailing Address - Fax:
Practice Address - Street 1:2269 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7418
Practice Address - Country:US
Practice Address - Phone:610-865-1362
Practice Address - Fax:610-865-9184
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028932L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist