Organization
GORDONS PHARMACY LLC
Active
Other names
Gordon's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN GORDON (PRESIDENT)
(912) 663-2674
Entity
Organization
Contact information
Practice address
3010 US HIGHWAY 80, UNIT B, BLOOMINGDALE, GA 31302-4558
(912) 988-1780
(912) 988-1784
Mailing address
3010 US HIGHWAY 80, UNIT B, BLOOMINGDALE, GA 31302-4558
(912) 988-1780
(912) 988-1784
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009832
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003125586A
—
GA
01
—
1162469
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/15/2012
Last updated
08/21/2012
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