Provider Demographics
NPI:1508188426
Name:MCCORMICK, JULIET GOTHELF
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:GOTHELF
Last Name:MCCORMICK
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 1:1001 BLYTHE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5863
Mailing Address - Country:US
Mailing Address - Phone:704-355-6900
Mailing Address - Fax:704-355-6903
Practice Address - Street 1:1001 BLYTHE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5863
Practice Address - Country:US
Practice Address - Phone:704-355-6900
Practice Address - Fax:704-355-6903
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist