Healthcare Provider Details

I. General information

NPI: 1790695831
Provider Name (Legal Business Name): JOSHUA KIM GORDON PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

159 N MAIN ST
SPANISH FORK UT
84660-1724
US

IV. Provider business mailing address

159 N MAIN ST
SPANISH FORK UT
84660-1724
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-8611
  • Fax: 801-798-9801
Mailing address:
  • Phone: 801-798-8611
  • Fax: 801-798-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8700093-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: