Organization
CHARLES R GORDON MD PA
Active
Other names
Roseland Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DEE DOWNING (GM)
(903) 720-9910
Entity
Organization
Contact information
Practice address
2737 S BROADWAY AVE, TYLER, TX 75701-5413
(903) 531-0590
(903) 531-0591
Mailing address
PO BOX 8967, TYLER, TX 75711-8967
(903) 531-0590
(903) 531-0591
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28882
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143181
PK
—
Enumeration date
11/20/2013
Last updated
02/20/2017
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