MEDICARE: MRS. VALERIE GORMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	043061	NY

General Provider Information

NPI Number	:	1346564218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE GORMAN

Provider Business Mailing Address
First Line	:	1054 W BEECH ST
Second Line	:
City	:	EAST ATLANTIC BEACH
State	:	NY
Zip	:	11561-1140
Country	:	US
Telephone Number	:	516-431-4455
Fax Number	:	516-431-4199

Provider Business Practice Location Address
First Line	:	1054 W BEECH ST
Second Line	:
City	:	EAST ATLANTIC BEACH
State	:	NY
Zip	:	11561-1140
Country	:	US
Telephone Number	:	516-431-4455
Fax Number	:	516-431-4199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	03/22/2010

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