Provider Demographics
NPI:1609318237
Name:SPROUL, GORDON CURTIS
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:CURTIS
Last Name:SPROUL
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 1:14040 15TH AVE NE
Mailing Address - Street 2:APT. 22E
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3183
Mailing Address - Country:US
Mailing Address - Phone:916-807-0402
Mailing Address - Fax:
Practice Address - Street 1:14040 15TH AVE NE
Practice Address - Street 2:APT. 22E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3183
Practice Address - Country:US
Practice Address - Phone:916-807-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60597021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist