Provider Demographics
NPI:1336213701
Name:MONTGOMERY, DAVID ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANDREW
Last Name:MONTGOMERY
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 1:204 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GAP
Mailing Address - State:PA
Mailing Address - Zip Code:16823-3502
Mailing Address - Country:US
Mailing Address - Phone:814-359-2660
Mailing Address - Fax:
Practice Address - Street 1:114 N ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1627
Practice Address - Country:US
Practice Address - Phone:814-359-2914
Practice Address - Fax:814-355-7628
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033667L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist