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General NPI Number Information
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NPI Number | 1528585973
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Entity Type | Individual
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Provider Name | ANDREA ELIZABETH GORDON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2017
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Last Update Date | 08/26/2017
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Provider Practice Location Address
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Address Line | 5295 34TH ST S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33711-4517
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Country | US
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Telephone | 727-864-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 871 IBIS WALK PL N UNIT 7207
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City | SAINT PETERSBURG
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State | FL
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Zip | 33716-3843
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Country | US
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Telephone | 706-459-8289
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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 | PS56941
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License Number State | FL
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