Healthcare Provider Details

I. General information

NPI: 1528464336
Provider Name (Legal Business Name): WEST GORDON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 W GORDON AVE STE 2
LAYTON UT
84041-5728
US

IV. Provider business mailing address

3225 W GORDON AVE STE 2
LAYTON UT
84041-5728
US

V. Phone/Fax

Practice location:
  • Phone: 801-544-7979
  • Fax: 801-682-8011
Mailing address:
  • Phone: 801-544-7979
  • Fax: 801-682-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9221852-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID BURNETT
Title or Position: SECRETARY
Credential:
Phone: 435-512-2102