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General NPI Number Information
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NPI Number | 1477276582
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Entity Type | Individual
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Provider Name | DAN YAW GORDON PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 812 E SAGINAW HWY
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City | GRAND LEDGE
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State | MI
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Zip | 48837-8410
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Country | US
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Telephone | 517-627-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 RUNAWAY BAY DR APT 2D
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City | LANSING
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State | MI
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Zip | 48917-8729
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Country | US
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Telephone | 682-240-1660
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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 | 21294021001
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License Number State | MI
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