Provider Demographics
NPI:1730584640
Name:MCCORMICK, RODNEY (DPH)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 IMPERIAL BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3479
Mailing Address - Country:US
Mailing Address - Phone:615-824-1215
Mailing Address - Fax:
Practice Address - Street 1:107 IMPERIAL BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3479
Practice Address - Country:US
Practice Address - Phone:615-824-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist