Provider Demographics
NPI:1194470542
Name:MCVAN, JOHN A IV
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MCVAN
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BETHLEHEM PIKE STE 40
Mailing Address - Street 2:
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1102
Mailing Address - Country:US
Mailing Address - Phone:215-646-1691
Mailing Address - Fax:
Practice Address - Street 1:1121 BETHLEHEM PIKE STE 40
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1102
Practice Address - Country:US
Practice Address - Phone:215-646-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040610L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist