Provider Demographics
NPI:1104706217
Name:DORMER, JAMES EDWARD JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:DORMER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5760
Mailing Address - Country:US
Mailing Address - Phone:570-455-6670
Mailing Address - Fax:
Practice Address - Street 1:100 WEIS LN
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1207
Practice Address - Country:US
Practice Address - Phone:570-455-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30292526183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician