Healthcare Provider Details

I. General information

NPI: 1194030106
Provider Name (Legal Business Name): CHERYLL ANN CORMIER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 6TH ST
THE DALLES OR
97058-3520
US

IV. Provider business mailing address

1233 SE CHAPMAN AVE
TROUTDALE OR
97060-2105
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-5680
  • Fax: 541-296-8587
Mailing address:
  • Phone: 503-314-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7270
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number7270
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: