Healthcare Provider Details

I. General information

NPI: 1265484844
Provider Name (Legal Business Name): MARGARET MARY GORDON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6654 UNIVERSAL AVE
LAS VEGAS NV
89142-3703
US

IV. Provider business mailing address

PO BOX 360001
NORTH LAS VEGAS NV
89036-8108
US

V. Phone/Fax

Practice location:
  • Phone: 702-626-3000
  • Fax:
Mailing address:
  • Phone: 702-444-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202012950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: