Individual
JEFFREY DEAN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
8400 UNIVERSITY AV NE, FRIDLEY, MN 55432
(651) 269-8796
Mailing address
1528 BERNE RD NE, FRIDLEY, MN 55421-1325
(651) 269-8796
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
112313
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112313
STATE BOARD IF PHARMACY
MN
Enumeration date
03/16/2021
Last updated
03/16/2021
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