Provider Demographics
NPI:1548577828
Name:GORDET, CHIP (RPH)
Entity Type:Individual
Prefix:
First Name:CHIP
Middle Name:
Last Name:GORDET
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 1:2128 DEVONPORT LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8830
Mailing Address - Country:US
Mailing Address - Phone:916-622-8166
Mailing Address - Fax:
Practice Address - Street 1:2128 DEVONPORT LOOP
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-8830
Practice Address - Country:US
Practice Address - Phone:916-622-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH28235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist