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NPI Code Detail

MEDICARE: ASHLEY GORDON

MEDICARE: ASHLEY GORDON
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
11835P0200XPediatric Pharmacist2014026872MO

General Provider Information

NPI Number : 1205491727
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY GORDON
Provider Business Mailing Address
First Line : 1 CHILDRENS PL
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-1002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 CHILDRENS PL
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-1002
Country : US
Telephone Number : 314-454-2618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2019
Last Update Date : 05/09/2019

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Directions to “ ASHLEY GORDON ” Practice Location

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