Healthcare Provider Details

I. General information

NPI: 1346564218
Provider Name (Legal Business Name): MRS. VALERIE GORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 W BEECH ST
EAST ATLANTIC BEACH NY
11561-1140
US

IV. Provider business mailing address

1054 W BEECH ST
EAST ATLANTIC BEACH NY
11561-1140
US

V. Phone/Fax

Practice location:
  • Phone: 516-431-4455
  • Fax: 516-431-4199
Mailing address:
  • Phone: 516-431-4455
  • Fax: 516-431-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: