Provider Demographics
NPI:1609477520
Name:GORDON, JOHN WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:GORDON
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 1:1254 US HIGHWAY 340 S
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:VA
Mailing Address - Zip Code:22849-4230
Mailing Address - Country:US
Mailing Address - Phone:540-578-3765
Mailing Address - Fax:
Practice Address - Street 1:1036 US HIGHWAY 211 W
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-5245
Practice Address - Country:US
Practice Address - Phone:540-743-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist