NPIMap

Organization Active NPI

Charles R Gordon MD PA

Doing business as Roseland Pharmacy

  • Community/Retail Pharmacy
  • Tyler, TX
National Provider Identifier
1346670726
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
28882 Issued in TX
Legal business name
CHARLES R GORDON MD PA
Doing business as
Roseland Pharmacy
Practice address
2737 S Broadway Ave
Tyler, TX 75701-5413
Phone
(903) 531-0590
Fax
(903) 531-0591
NPI assigned
Nov 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Dee Downing
Title
GM
Phone
(903) 720-9910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 28882 TX Primary

Addresses

Primary practice location

2737 S Broadway Ave
Tyler, TX 75701-5413

Mailing address

PO Box 8967
Tyler, TX 75711-8967
Phone (903) 531-0590

Other identifiers 1

IdentifierTypeStateIssuer
2143181OtherPK

Other names 1

  • Roseland Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Charles R Gordon MD PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1346670726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8967",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757118967",
            "telephone_number": "903-531-0590",
            "fax_number": "903-531-0591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015413",
            "telephone_number": "903-531-0590",
            "fax_number": "903-531-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES R GORDON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "DOWNING",
        "authorized_official_first_name": "DEE",
        "authorized_official_title_or_position": "GM",
        "authorized_official_telephone_number": "903-720-9910"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "28882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143181",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roseland Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.