Provider Demographics
NPI:1427460401
Name:DONMOYER, TERRY (TERRY)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:DONMOYER
Suffix:
Gender:M
Credentials:TERRY
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:RAY
Other - Last Name:DONMOYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 S TULPEHOCKEN ST
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-1011
Mailing Address - Country:US
Mailing Address - Phone:570-345-4966
Mailing Address - Fax:570-345-3927
Practice Address - Street 1:101 S TULPEHOCKEN ST
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-1011
Practice Address - Country:US
Practice Address - Phone:570-345-4966
Practice Address - Fax:570-345-3927
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030002L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5704415534OtherCELL PHONE