Provider Demographics
NPI:1548249121
Name:MCGIBONEY, DANA GLYNN (RPH)
Entity type:Individual
Prefix:MR
First Name:DANA
Middle Name:GLYNN
Last Name:MCGIBONEY
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 1:123 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1900
Mailing Address - Country:US
Mailing Address - Phone:267-382-0573
Mailing Address - Fax:267-382-0573
Practice Address - Street 1:123 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1900
Practice Address - Country:US
Practice Address - Phone:267-382-0573
Practice Address - Fax:267-382-0573
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040871L183500000X
NJ28RI02999300183500000X
MD17381183500000X
DEA1-0003562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist