Provider Demographics
NPI:1285715029
Name:AYRES, JOHN DAVID JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:AYRES
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1931
Mailing Address - Country:US
Mailing Address - Phone:570-271-4500
Mailing Address - Fax:570-271-4537
Practice Address - Street 1:200 STATE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-9103
Practice Address - Country:US
Practice Address - Phone:570-271-4500
Practice Address - Fax:570-271-4537
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARP042218R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist