Provider Demographics
NPI:1003488339
Name:MORDON LLC
Entity Type:Organization
Organization Name:MORDON LLC
Other - Org Name:FAIRMONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:832-670-2616
Mailing Address - Street 1:10407 W FAIRMONT PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6018
Mailing Address - Country:US
Mailing Address - Phone:281-941-4976
Mailing Address - Fax:281-941-4871
Practice Address - Street 1:10407 W FAIRMONT PKWY STE C
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6018
Practice Address - Country:US
Practice Address - Phone:281-941-4976
Practice Address - Fax:281-941-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy