Provider Demographics
NPI:1194062257
Name:MCDONALD-DORMAN, PAMELA ELIZABETH (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:MCDONALD-DORMAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2152
Mailing Address - Country:US
Mailing Address - Phone:941-629-0084
Mailing Address - Fax:941-629-1020
Practice Address - Street 1:4265 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2152
Practice Address - Country:US
Practice Address - Phone:941-629-0084
Practice Address - Fax:941-629-1020
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist