Provider Demographics
NPI:1477173342
Name:GORDON, THOMASINA (CPHT)
Entity Type:Individual
Prefix:
First Name:THOMASINA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5215
Mailing Address - Country:US
Mailing Address - Phone:615-891-8599
Mailing Address - Fax:
Practice Address - Street 1:718 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2151
Practice Address - Country:US
Practice Address - Phone:615-343-1801
Practice Address - Fax:615-242-1151
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21166183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician