Healthcare Provider Details

I. General information

NPI: 1376572420
Provider Name (Legal Business Name): GORDON SCOTT SACKS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

777 HIGHLAND AVE
MADISON WI
53705-2222
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-7287
  • Fax: 608-263-9424
Mailing address:
  • Phone: 608-262-9491
  • Fax: 608-261-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number13791
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: