Healthcare Provider Details

I. General information

NPI: 1235114240
Provider Name (Legal Business Name): STEPHANIE W. MCCORMICK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

924 BROOKHAVEN DR
ST AUGUSTINE FL
32092-1057
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-4157
  • Fax: 904-244-4272
Mailing address:
  • Phone: 904-244-4157
  • Fax: 904-244-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS29670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: