Individual
JUSTIN GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9812 NE HIGHWAY 99, VANCOUVER, WA 98665-8935
(702) 413-3530
Mailing address
2719 NE 92ND CIR, VANCOUVER, WA 98665-9576
(702) 413-3530
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
CPT-0012227
OR
183700000X
Pharmacy Technician
Primary
VA-60988386
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CPT-0012227
—
OR
05
—
VA-60988386
—
WA
Enumeration date
07/27/2020
Last updated
07/27/2020
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