Provider Demographics
NPI:1013187657
Name:GORDON, STUART IRVING (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:IRVING
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3008
Mailing Address - Country:US
Mailing Address - Phone:336-272-7139
Mailing Address - Fax:336-272-4779
Practice Address - Street 1:120 E LINDSAY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3008
Practice Address - Country:US
Practice Address - Phone:336-272-7139
Practice Address - Fax:336-272-4779
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist