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General NPI Number Information
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NPI Number | 1831236991
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Entity Type | Organization
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Legal Business Name | GORDON'S PHARMACY AND GIFTS LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 314 SOUTH MAIN STREET
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City | CANYONVILLE
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State | OR
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Zip | 97417-0746
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Country | US
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Telephone | 541-839-4452
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Fax | 541-839-4254
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Provider Business Mailing Address
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Address Line | PO BOX 746
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City | CANYONVILLE
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State | OR
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Zip | 97417-0746
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Country | US
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Telephone | 541-839-4452
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Fax | 541-839-4254
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID ALLEN STEVENS
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Credential | R.PH.
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Telephone | 541-839-4452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | RP0000162CS
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP0000162CS
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License Number State | OR
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