Healthcare Provider Details

I. General information

NPI: 1477173342
Provider Name (Legal Business Name): THOMASINA GORDON CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 MELROSE AVE
NASHVILLE TN
37211-2151
US

IV. Provider business mailing address

1408 MONTGOMERY AVE
NASHVILLE TN
37207-5215
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-1801
  • Fax: 615-242-1151
Mailing address:
  • Phone: 615-891-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number21166
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: