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General NPI Number Information
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NPI Number | 1114340064
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Entity Type | Individual
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Provider Name | STEPHEN R GORDON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 17823 CRICKET HILL DR
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City | GERMANTOWN
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State | MD
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Zip | 20874-3462
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Country | US
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Telephone | 301-980-6568
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Fax |
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Provider Business Mailing Address
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Address Line | 17823 CRICKET HILL DR
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City | GERMANTOWN
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State | MD
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Zip | 20874-3462
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Country | US
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Telephone | 301-980-6568
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Fax |
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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 | 0202009192
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10998
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP032116L
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License Number State | PA
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