Provider Demographics
NPI:1073645370
Name:GORMLEY, LORI ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:GORMLEY
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 1:204 BEN TITUS RD
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4823
Mailing Address - Country:US
Mailing Address - Phone:570-668-6464
Mailing Address - Fax:
Practice Address - Street 1:1 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6520
Practice Address - Country:US
Practice Address - Phone:570-454-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042483L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist