Provider Demographics
NPI:1720371339
Name:MCCORMACK, DAWN RENEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RENEE
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 PROPHET DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7820
Mailing Address - Country:US
Mailing Address - Phone:630-842-5055
Mailing Address - Fax:
Practice Address - Street 1:1817 MARTIN LUTHER KING PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3585
Practice Address - Country:US
Practice Address - Phone:919-402-1917
Practice Address - Fax:919-402-1941
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20029183500000X
FLPS39959183500000X
IL051040570183500000X
IN26017989A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist