Provider Demographics
NPI:1093204034
Name:GORDON, ARI HEATON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARI
Middle Name:HEATON
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 HILLHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4407
Mailing Address - Country:US
Mailing Address - Phone:323-663-8017
Mailing Address - Fax:323-663-0770
Practice Address - Street 1:1803 HILLHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4407
Practice Address - Country:US
Practice Address - Phone:323-663-8017
Practice Address - Fax:323-663-0770
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist