Provider Demographics
NPI:1427346923
Name:DORMEUS, GUERLINE (PHARMD,)
Entity type:Individual
Prefix:DR
First Name:GUERLINE
Middle Name:
Last Name:DORMEUS
Suffix:
Gender:F
Credentials:PHARMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19038 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3341
Mailing Address - Country:US
Mailing Address - Phone:718-341-3103
Mailing Address - Fax:
Practice Address - Street 1:265 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2933
Practice Address - Country:US
Practice Address - Phone:516-681-1425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0557013183500000X
PARP445247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist