Provider Demographics
NPI:1164737821
Name:GORNICK, JOSEPH PEDER (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PEDER
Last Name:GORNICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 RUSTLING TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5024
Mailing Address - Country:US
Mailing Address - Phone:713-870-7887
Mailing Address - Fax:281-292-6956
Practice Address - Street 1:9595 SIX PINES DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1531
Practice Address - Country:US
Practice Address - Phone:281-292-3962
Practice Address - Fax:281-292-6956
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist