Healthcare Provider Details

I. General information

NPI: 1164347308
Provider Name (Legal Business Name): GORDON VANSCOY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MERCHANT LN
PITTSBURGH PA
15205-6710
US

IV. Provider business mailing address

1777 GALLEON DR
NAPLES FL
34102-7719
US

V. Phone/Fax

Practice location:
  • Phone: 855-826-7269
  • Fax:
Mailing address:
  • Phone: 412-855-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP033773L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: