Provider Demographics
NPI:1194373282
Name:GORDON, DONNA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 NORTH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2756
Mailing Address - Country:US
Mailing Address - Phone:802-862-7752
Mailing Address - Fax:802-862-7815
Practice Address - Street 1:1127 NORTH AVE STE 11
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2756
Practice Address - Country:US
Practice Address - Phone:802-862-7752
Practice Address - Fax:802-862-7815
Is Sole Proprietor?:No
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist