Provider Demographics
NPI:1881928778
Name:GONYEA, MICHAEL JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:GONYEA
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 1:3400 HARTZDALE DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7213
Mailing Address - Country:US
Mailing Address - Phone:717-409-3109
Mailing Address - Fax:717-409-3103
Practice Address - Street 1:3400 HARTZDALE DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7213
Practice Address - Country:US
Practice Address - Phone:717-409-3109
Practice Address - Fax:717-409-3103
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042059R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist