Healthcare Provider Details

I. General information

NPI: 1093625238
Provider Name (Legal Business Name): MADISON GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

IV. Provider business mailing address

216 MAPLE ST
FRANKLIN PA
16323-2847
US

V. Phone/Fax

Practice location:
  • Phone: 216-358-2802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03447204
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: