Active NPI
Randolph M. Gorder, R.PH.
- Pharmacist
- Kingman, AZ
National Provider Identifier
1689974198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 8167
- Practice address
- 3970 Stockton Hill Rd
Kingman, AZ 86409-3002 - Phone
- (928) 681-4903
- NPI assigned
- Oct 31, 2010
- Last updated
- Nov 1, 2010
- 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 | 8167 | AZ | Primary |
Addresses
Primary practice location
3970 Stockton Hill Rd
Kingman, AZ 86409-3002
Mailing address
3970 Stockton Hill Rd
Kingman, AZ 86409-3002
Phone (928) 681-4903
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4042 | Other | SD | SD PHARMACY LICENSE # |
| 8167 | Other | AZ | AZ PHARMACY LICENSE |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8167 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288569600000",
"number": "1689974198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3970 STOCKTON HILL RD",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864093002",
"telephone_number": "928-681-4903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3970 STOCKTON HILL RD",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864093002",
"telephone_number": "928-681-4903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDER",
"first_name": "RANDOLPH",
"middle_name": "M.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-31",
"last_updated": "2010-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "8167",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SD PHARMACY LICENSE #",
"identifier": "4042",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ PHARMACY LICENSE",
"identifier": "8167",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.