Healthcare Provider Details

I. General information

NPI: 1831236991
Provider Name (Legal Business Name): GORDONS PHARMACY & GIFTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SOUTH MAIN STREET
CANYONVILLE OR
97417-0746
US

IV. Provider business mailing address

PO BOX B
ILWACO WA
98624-0167
US

V. Phone/Fax

Practice location:
  • Phone: 541-839-4452
  • Fax: 541-839-4254
Mailing address:
  • Phone: 541-839-4452
  • Fax: 541-839-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP0000162CS
License Number StateOR

VIII. Authorized Official

Name: JEFFREY HARRELL
Title or Position: OWNER
Credential:
Phone: 360-859-8659