MEDICARE: DR. MARGARET MARY GORDON PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	0202012950	VA

General Provider Information

NPI Number	:	1265484844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET MARY GORDON PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 360001
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89036-8108
Country	:	US
Telephone Number	:	702-444-3083
Fax Number	:

Provider Business Practice Location Address
First Line	:	6654 UNIVERSAL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-3703
Country	:	US
Telephone Number	:	702-626-3000
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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