Provider Demographics
NPI:1033182159
Name:GORDON, REBECCA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 MAYFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6011
Mailing Address - Country:US
Mailing Address - Phone:904-254-7902
Mailing Address - Fax:904-542-7697
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7422
Practice Address - Fax:904-542-7697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist