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MR. MARK GORDON PHARMD
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1841576543
Individual Registrant:MR. MARK GORDON PHARMD
Gender: M
Not Sole Proprietor
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
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
Tel: 920-730-8218 Fax: 920-730-8287
Registration Information:
NPI: 1841576543
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | WI | 15530-040 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
