Provider Demographics
NPI:1588955991
Name:GORMAN, JOHN HOWELL (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HOWELL
Last Name:GORMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6840
Mailing Address - Country:US
Mailing Address - Phone:757-564-6906
Mailing Address - Fax:
Practice Address - Street 1:4501 NEWS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7803
Practice Address - Country:US
Practice Address - Phone:757-220-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10741-040183500000X
VA0202205674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist