Provider Demographics
NPI:1346764560
Name:GORDON, BRADLEY GENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:GENE
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 1:2715 E 36TH AVE APT 3205
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4582
Mailing Address - Country:US
Mailing Address - Phone:509-969-0326
Mailing Address - Fax:
Practice Address - Street 1:2610 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4806
Practice Address - Country:US
Practice Address - Phone:509-969-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2017-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60758394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist