Organization
AS GORDON ENTERPRISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AVERILL GORDON PHARMD (OWNER/ PRESIDENT)
(904) 477-3853
Entity
Organization
Contact information
Practice address
102 CENTER ST, GRAYSLAKE, IL 60030-1533
(904) 477-3853
Mailing address
1282 CHESTERFIELD LN, GRAYSLAKE, IL 60030-3797
(904) 477-3853
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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