Active NPI
Averill D Gordon, PHARM.D.
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Waukegan, IL
National Provider Identifier
1164419305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 051.294042
- Practice address
- 2702 Grand Ave
Waukegan, IL 60085-2407 - Phone
- (224) 441-3008
- NPI assigned
- Oct 3, 2005
- Last updated
- Feb 14, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS38857 | FL | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 051.294042 | IL | Primary |
Addresses
Primary practice location
2702 Grand Ave
Waukegan, IL 60085-2407
Mailing address
1282 Chesterfield LN
Grayslake, IL 60030-3797
Phone (904) 477-3853
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS38857 | FL | MD | Pharmacist |
| 051.294042 | IL | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| As Gordon Enterprise LLC | Current | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinic/Center
- Grayslake, IL
- NPI 1336884659
-
dba Tu Pharmacy
- Long Term Care Pharmacy
- Waukegan, IL
- NPI 1255047825
-
dba Tu Pharmacy
- Community/Retail Pharmacy
- Waukegan, IL
- NPI 1669139648
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707868800000",
"number": "1164419305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1282 CHESTERFIELD LN",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600303797",
"telephone_number": "904-477-3853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2702 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852407",
"telephone_number": "224-441-3008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "AVERILL",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2024-02-14",
"certification_date": "2024-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS38857",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "IL",
"license": "051.294042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.