Provider Demographics
NPI:1437157104
Name:KORMAN LLC
Entity Type:Organization
Organization Name:KORMAN LLC
Other - Org Name:KORMAN HEALTHCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-365-0222
Mailing Address - Street 1:5787 W ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2749
Mailing Address - Country:US
Mailing Address - Phone:480-365-0222
Mailing Address - Fax:480-365-0221
Practice Address - Street 1:5787 W ERIE ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2749
Practice Address - Country:US
Practice Address - Phone:480-365-0222
Practice Address - Fax:480-365-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BX2000X, 333600000X, 3336C0004X
AZY0038053336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158340Medicaid
1991733OtherPK
1991733OtherPK