Provider Demographics
NPI:1417056243
Name:GORHAM, DAVID LEROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEROY
Last Name:GORHAM
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 1:1705 38TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2329
Mailing Address - Country:US
Mailing Address - Phone:202-575-2071
Mailing Address - Fax:202-575-2481
Practice Address - Street 1:VETERANS ADMINISTRATION MEDICAL CTR
Practice Address - Street 2:50 IRVING STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8233
Practice Address - Fax:202-745-8639
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist