Provider Demographics
NPI:1558834200
Name:POKORNY, GORDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:
Last Name:POKORNY
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 1:271 WALNUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4158
Mailing Address - Country:US
Mailing Address - Phone:419-239-4151
Mailing Address - Fax:
Practice Address - Street 1:1575 LYONS RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1881
Practice Address - Country:US
Practice Address - Phone:937-439-9779
Practice Address - Fax:937-439-5443
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist