Active NPI
Mark Gordon, PHARMD
- Pharmacist
- Grand Chute, WI
National Provider Identifier
1841576543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15530-040
- Practice address
- 1305 N Casaloma Dr
Grand Chute, WI 54913-8848 - Phone
- (920) 730-8218
- Fax
- (920) 730-8287
- NPI assigned
- Oct 25, 2011
- Last updated
- Oct 25, 2011
- 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 | 15530-040 | WI | Primary |
Addresses
Primary practice location
1305 N Casaloma Dr
Grand Chute, WI 54913-8848
Mailing address
1305 N Casaloma Dr
Grand Chute, WI 54913-8848
Phone (920) 730-8218
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 |
|---|---|---|---|
| 15530-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1841576543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 N CASALOMA DR",
"city": "GRAND CHUTE",
"state": "WI",
"postal_code": "549138848",
"telephone_number": "920-730-8218",
"fax_number": "920-730-8287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 N CASALOMA DR",
"city": "GRAND CHUTE",
"state": "WI",
"postal_code": "549138848",
"telephone_number": "920-730-8218",
"fax_number": "920-730-8287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MARK",
"name_prefix": "Mr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-25",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "15530-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Chute, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.