Active NPI
Sudan Cory Gordon, PHARMD
- Pharmacist
- Phoenix, AZ
National Provider Identifier
1255046454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S023645
- Practice address
- 635 E Baseline Rd
Phoenix, AZ 85042-6551 - Phone
- (602) 323-3435
- NPI assigned
- Jan 23, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S023645 | AZ | Primary |
Addresses
Primary practice location
635 E Baseline Rd
Phoenix, AZ 85042-6551
Mailing address
1322 E Glass LN
Phoenix, AZ 85042-5819
Phone (202) 270-0900
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 |
|---|---|---|---|
| S023645 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674432000000",
"number": "1255046454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1322 E GLASS LN",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850425819",
"telephone_number": "202-270-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 E BASELINE RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850426551",
"telephone_number": "602-323-3435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "SUDAN",
"middle_name": "CORY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-23",
"last_updated": "2023-01-23",
"certification_date": "2023-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S023645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.