Provider Demographics
NPI:1376764506
Name:MCCORMICK, LAUREN JANE (RPH)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JANE
Last Name:MCCORMICK
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 1:202 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2202
Mailing Address - Country:US
Mailing Address - Phone:609-267-8537
Mailing Address - Fax:
Practice Address - Street 1:200 TRENTON RD
Practice Address - Street 2:DEBORAH HEART AND LUNG CENTER
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-1705
Practice Address - Country:US
Practice Address - Phone:609-893-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02065600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist