Provider Demographics
NPI:1083022636
Name:MCINTIRE, DAVID LEE (R,PH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:MCINTIRE
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 1:15 CENTENNIAL WAY
Mailing Address - Street 2:RITE AID PHARMACY 01709
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683
Mailing Address - Country:US
Mailing Address - Phone:724-887-4727
Mailing Address - Fax:
Practice Address - Street 1:15 CENTENNIAL WAY
Practice Address - Street 2:RITE AID PHARMACY 01709
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683
Practice Address - Country:US
Practice Address - Phone:724-887-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP1003018183500000X
PARP028794L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist