Healthcare Provider Details

I. General information

NPI: 1801880562
Provider Name (Legal Business Name): BRUCE MYRON GORDON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 OTTO LN
GAMBRILLS MD
21054-1056
US

IV. Provider business mailing address

310 OTTO LN
GAMBRILLS MD
21054-1056
US

V. Phone/Fax

Practice location:
  • Phone: 410-674-5181
  • Fax:
Mailing address:
  • Phone: 410-674-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9123
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: