Provider Demographics
NPI:1346564218
Name:GORMAN, VALERIE
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1140
Mailing Address - Country:US
Mailing Address - Phone:516-431-4455
Mailing Address - Fax:516-431-4199
Practice Address - Street 1:1054 W BEECH ST
Practice Address - Street 2:
Practice Address - City:EAST ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1140
Practice Address - Country:US
Practice Address - Phone:516-431-4455
Practice Address - Fax:516-431-4199
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist