Provider Demographics
NPI:1003040486
Name:RORRISON, EDWARD JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOHN
Last Name:RORRISON
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-0326
Mailing Address - Country:US
Mailing Address - Phone:631-924-7188
Mailing Address - Fax:631-370-1671
Practice Address - Street 1:197 HALF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5861
Practice Address - Country:US
Practice Address - Phone:631-370-1669
Practice Address - Fax:631-370-1671
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist