Provider Demographics
NPI:1487247441
Name:MCGONIGLE, KEVIN JOHN (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:MCGONIGLE
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 1:308 WISCHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-1003
Mailing Address - Country:US
Mailing Address - Phone:215-885-6418
Mailing Address - Fax:
Practice Address - Street 1:308 WISCHMAN AVE
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-1003
Practice Address - Country:US
Practice Address - Phone:215-885-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036058L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist