John Gordon, RPH
Individual provider Active NPI Pharmacist · Tequesta, FL
NPI 1720566151 · NPPES record last updated Jul 28, 2018
Key facts
- NPI
- 1720566151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS28821 (FL)
- Practice address
- 18740 SE River Ridge Rd
Tequesta, FL 33469-8106 - Phone
- (561) 748-0365
- NPI assigned
- Jul 28, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS28821 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS28821 | FL | Yes |
Addresses
Primary practice location
18740 SE River Ridge Rd
Tequesta, FL 33469-8106
Mailing address
18740 SE River Ridge Rd
Tequesta, FL 33469-8106
Phone (561) 748-0365
Other providers in Tequesta, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.