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General NPI Number Information
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NPI Number | 1033182159
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Entity Type | Individual
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Provider Name | REBECCA J GORDON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2080 CHILD ST PHARMACY DEPT
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-7422
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Fax | 904-542-7697
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Provider Business Mailing Address
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Address Line | 3237 MAYFLOWER ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6011
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Country | US
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Telephone | 904-254-7902
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Fax | 904-542-7697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | IL
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