Provider Demographics
NPI:1568976827
Name:GORMLEY, DEBORA KAY
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:KAY
Last Name:GORMLEY
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 1:8970 PENSACOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1927
Mailing Address - Country:US
Mailing Address - Phone:850-484-3777
Mailing Address - Fax:850-476-8596
Practice Address - Street 1:8970 PENSACOLA BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1927
Practice Address - Country:US
Practice Address - Phone:850-484-3777
Practice Address - Fax:850-476-8596
Is Sole Proprietor?:No
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist