Provider Demographics
NPI:1861831810
Name:MCCORMICK, JAMES ROBERT (CPHT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4304
Mailing Address - Country:US
Mailing Address - Phone:608-333-3423
Mailing Address - Fax:
Practice Address - Street 1:2720 S 163RD ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3610
Practice Address - Country:US
Practice Address - Phone:262-780-1910
Practice Address - Fax:262-780-1914
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56010710209704183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician