Provider Demographics
NPI:1447454483
Name:MCCORVEY, EDDIE NMN JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:NMN
Last Name:MCCORVEY
Suffix:JR
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 1:1671 SW 159TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2343
Mailing Address - Country:US
Mailing Address - Phone:954-430-7321
Mailing Address - Fax:
Practice Address - Street 1:99434 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2459
Practice Address - Country:US
Practice Address - Phone:305-451-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 15158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist