MEDICARE: DR. GUERLINE DORMEUS PHARM.D,

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	0557013	NY
2	183500000X	Pharmacist	RP445247	PA

General Provider Information

NPI Number	:	1427346923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUERLINE DORMEUS PHARM.D,

Provider Business Mailing Address
First Line	:	19038 118TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3341
Country	:	US
Telephone Number	:	718-341-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 N BROADWAY
Second Line	:
City	:	HICKSVILLE
State	:	NY
Zip	:	11801-2933
Country	:	US
Telephone Number	:	516-681-1425
Fax Number	:

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	07/18/2011

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