MEDICARE: DR. STEPHEN R 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	0202009192	VA
2	183500000X	Pharmacist	10998	MD
3	183500000X	Pharmacist	RP032116L	PA

General Provider Information

NPI Number	:	1114340064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN R GORDON PHARMD

Provider Business Mailing Address
First Line	:	17823 CRICKET HILL DR
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-3462
Country	:	US
Telephone Number	:	301-980-6568
Fax Number	:

Provider Business Practice Location Address
First Line	:	17823 CRICKET HILL DR
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-3462
Country	:	US
Telephone Number	:	301-980-6568
Fax Number	:

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

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	10/19/2015

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