Healthcare Provider Details

I. General information

NPI: 1851577290
Provider Name (Legal Business Name): KORMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5783 W ERIE ST
CHANDLER AZ
85226-2749
US

IV. Provider business mailing address

5783 W ERIE ST
CHANDLER AZ
85226-2749
US

V. Phone/Fax

Practice location:
  • Phone: 480-365-0222
  • Fax: 480-365-0221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2776
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN HARDMAN
Title or Position: CFO OWNER PHCST
Credential:
Phone: 480-707-3390