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NPI Code Detail

MEDICARE: GORDIUM RX, LLC

MEDICARE: GORDIUM RX, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail PharmacyPA9108944FL

General Provider Information

NPI Number : 1902352958
Entity Type Code : Organization
Provider Name (Legal Business Name) : GORDIUM RX, LLC
Provider Business Mailing Address
First Line : 4723 W ATLANTIC AVE STE 2
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33445-3865
Country : US
Telephone Number : 561-562-0674
Fax Number : 561-265-5673
Provider Business Practice Location Address
First Line : 4723 W ATLANTIC AVE STE 2
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33445-3865
Country : US
Telephone Number : 561-562-0674
Fax Number : 561-265-5673
Authorized Official
Title or Position : PHYSICIANS ASSISTANT
Name : ARPANA SHIVDASANI
Credential : P.A.
Telephone Number : 561-562-0674
Provider Enumeration Date : 08/30/2016
Last Update Date : 08/30/2016

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Directions to “GORDIUM RX, LLC ” Practice Location

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