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General NPI Number Information
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NPI Number | 1649093378
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Entity Type | Individual
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Provider Name | MR. GARRY L GORDON II
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Gender | Male
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1797 ROANE STATE HWY
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City | HARRIMAN
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State | TN
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Zip | 37748-8306
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Country | US
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Telephone | 865-717-2835
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Fax |
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Provider Business Mailing Address
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Address Line | 104 VALLEY FORGE DR
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City | OAK RIDGE
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State | TN
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Zip | 37830-6671
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Country | US
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Telephone | 865-466-7372
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 0000084995
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License Number State | TN
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