Provider Demographics
NPI:1891022158
Name:GORMAN, ANN M (RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:GORMAN
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 1:5502 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2340
Mailing Address - Country:US
Mailing Address - Phone:206-217-5504
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W
Practice Address - Street 2:SUITE #330
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4612
Practice Address - Country:US
Practice Address - Phone:425-670-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist