Provider Demographics
NPI:1659975696
Name:CORMIER, NORMAN S
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:S
Last Name:CORMIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E RED BANK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1610
Mailing Address - Country:US
Mailing Address - Phone:856-853-4600
Mailing Address - Fax:856-853-0332
Practice Address - Street 1:25 E RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1610
Practice Address - Country:US
Practice Address - Phone:856-853-4600
Practice Address - Fax:856-853-0332
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01640100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist