Healthcare Provider Details

I. General information

NPI: 1689647000
Provider Name (Legal Business Name): RICHARD L GORDON PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NAVAL MEDICAL CENTER
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

10771 BLACK MOUNTAIN RD SPC 74
SAN DIEGO CA
92126-2940
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9495
  • Fax:
Mailing address:
  • Phone: 858-829-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number43718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: