Individual
DR. JAMIE VIRGINIA HACK GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
1650 COCHRANE CIR, FORT CARSON, CO 80913-4613
(719) 526-7410
Mailing address
9855 HUNTING TR, LAKE WORTH, FL 33467-3515
(561) 968-3330
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202214400
VA
183500000X
Pharmacist
PHA.0023069
CO
183500000X
Pharmacist
Primary
PS45154
FL
183500000X
Pharmacist
RP0012244
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202214400
VIRGINIA BOARD OF PHARMACY
VA
01
—
PHA.0023069
COLORADO BOARD OF PHARMACY
CO
01
—
PS45154
FLORIDA BOARD OF PHARMACY
FL
01
—
RP0012244
WEST VIRGINIA BOARD OF PHARMACY
WV
Enumeration date
09/13/2011
Last updated
10/21/2021
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