Provider Demographics
NPI:1497368815
Name:MCCORMICK, IAN CARTER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:CARTER
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 MAYNARDVILLE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807
Mailing Address - Country:US
Mailing Address - Phone:865-992-8581
Mailing Address - Fax:865-992-2528
Practice Address - Street 1:2710 MAYNARDVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807
Practice Address - Country:US
Practice Address - Phone:865-992-8581
Practice Address - Fax:865-992-2528
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000043644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist