Provider Demographics
NPI:1306827845
Name:GORMAN, JANE F (RPH)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:F
Last Name:GORMAN
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 1:219 NOYAC RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-1440
Mailing Address - Country:US
Mailing Address - Phone:631-726-8245
Mailing Address - Fax:631-726-8805
Practice Address - Street 1:219 NOYAC RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-1440
Practice Address - Country:US
Practice Address - Phone:631-726-8245
Practice Address - Fax:631-726-8805
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist