Provider Demographics
NPI:1568747343
Name:GORODESS, WARREN EDWARD
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:EDWARD
Last Name:GORODESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 JOG RD
Mailing Address - Street 2:
Mailing Address - City:WEST DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:561-865-1527
Mailing Address - Fax:561-865-2539
Practice Address - Street 1:13950 JOG RD
Practice Address - Street 2:
Practice Address - City:WEST DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-865-1527
Practice Address - Fax:561-865-2539
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS034076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist