Provider Demographics
NPI:1538463088
Name:MCCORMICK, WILLIAM GERALD (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GERALD
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-663-5678
Mailing Address - Fax:603-663-3278
Practice Address - Street 1:175 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-663-5678
Practice Address - Fax:603-663-3278
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2310183500000X
NJ28RI02942900183500000X
AK1827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist