Shawn Michael Gordon, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

116653 Issued in MN

Practice address

2505 W Division St
Saint Cloud, MN 56301-3837

Phone

(320) 251-9433

NPI assigned

Dec 29, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Saint Cloud, MN
  • NPI 1326053638
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1154918779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 W DIVISION ST",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563013837",
            "telephone_number": "320-251-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 W DIVISION ST",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563013837",
            "telephone_number": "320-251-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SHAWN",
        "middle_name": "MICHAEL",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-29",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "116653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "computer",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2505 W Division St",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563013837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Marshall Goodman, M.D.
• Shawanda Denise Goodman, APRN
• William L Goodmanson, CRNA
• Charles Gordon
• Nicole Mary Gordon, RN
• Tracy Gordon, LICSW
• Holly Christina Gosiak, RN
• Darlyn Gilberte Gossiho
• Mitchell Vincent Gossman, MD
• Karen Rae Gozel, APRN, CNS

• Pharmacist in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.