Provider Demographics
NPI:1215949763
Name:MCINTYRE, PHILIP DONALD (R PH)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DONALD
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 S ATHERTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4628
Mailing Address - Country:US
Mailing Address - Phone:814-238-2712
Mailing Address - Fax:814-238-0480
Practice Address - Street 1:724 S ATHERTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4628
Practice Address - Country:US
Practice Address - Phone:814-238-2712
Practice Address - Fax:814-238-0480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030163L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist