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General NPI Number Information
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NPI Number | 1477835742
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Entity Type | Individual
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Provider Name | JAMIE VIRGINIA HACK GORDON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR
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City | FORT CARSON
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State | CO
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Zip | 80913-4613
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Country | US
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Telephone | 719-526-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 9855 HUNTING TR
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City | LAKE WORTH
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State | FL
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Zip | 33467-3515
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Country | US
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Telephone | 561-968-3330
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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 | 0202214400
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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 | PHA.0023069
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License Number State | CO
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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 | RP0012244
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS45154
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License Number State | FL
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