Provider Demographics
NPI:1457348955
Name:MCCORMICK, MICHAEL T (RPH,MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:JAMES A. HALEY VA HOSPTIAL, PHARMACY SERVICE (119)
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-7519
Mailing Address - Fax:818-979-3661
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:JAMES A. HALEY VA HOSPTIAL, PHARMACY SERVICE (119)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7519
Practice Address - Fax:818-979-3661
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112015-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist