Provider Demographics
NPI:1194030106
Name:CORMIER, CHERYLL ANN (RPH)
Entity type:Individual
Prefix:
First Name:CHERYLL
Middle Name:ANN
Last Name:CORMIER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SE CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2105
Mailing Address - Country:US
Mailing Address - Phone:503-314-8511
Mailing Address - Fax:
Practice Address - Street 1:1400 W 6TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3520
Practice Address - Country:US
Practice Address - Phone:541-298-5680
Practice Address - Fax:541-296-8587
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7270183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist