MEDICARE: DR. ARI HEATON GORDON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	70159	CA

General Provider Information

NPI Number	:	1093204034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARI HEATON GORDON PHARMD

Provider Business Mailing Address
First Line	:	1803 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4407
Country	:	US
Telephone Number	:	323-663-8017
Fax Number	:	323-663-0770

Provider Business Practice Location Address
First Line	:	1803 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4407
Country	:	US
Telephone Number	:	323-663-8017
Fax Number	:	323-663-0770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	05/04/2018

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