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MR. MARK GORDON PHARMD

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1841576543

Individual Registrant:
MR. MARK  GORDON PHARMD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1305 N CASALOMA DR  GRAND CHUTE, WI 54913-8848 US
Tel: 920-730-8218  Fax: 920-730-8287

Contact information for business:
1305 N CASALOMA DR  GRAND CHUTE, WI 54913-8848 US
Tel: 920-730-8218  Fax: 920-730-8287

Registration Information:
NPI: 1841576543
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
WI15530-040

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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