Provider Demographics
NPI:1083615363
Name:GORDY, JUDITH KANNER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:KANNER
Last Name:GORDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2332
Mailing Address - Country:US
Mailing Address - Phone:973-736-1943
Mailing Address - Fax:
Practice Address - Street 1:68 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2332
Practice Address - Country:US
Practice Address - Phone:973-736-1943
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02859700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist