Provider Demographics
NPI:1871371450
Name:EYERLY, KEVIN PAUL JR (RPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:EYERLY
Suffix:JR
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 1:5321 LOOMIS ST LOT 236
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1818
Mailing Address - Country:US
Mailing Address - Phone:814-823-4556
Mailing Address - Fax:
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1818
Practice Address - Country:US
Practice Address - Phone:814-725-9684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist