Provider Demographics
NPI:1972103133
Name:GORMAN, NIKKI (RPH)
Entity type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:
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 1:1670 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3444
Mailing Address - Country:US
Mailing Address - Phone:972-562-4401
Mailing Address - Fax:972-562-4503
Practice Address - Street 1:1670 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3444
Practice Address - Country:US
Practice Address - Phone:972-552-4401
Practice Address - Fax:972-562-4503
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist