Provider Demographics
NPI:1639298946
Name:GORDON, ALVAH GENE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ALVAH
Middle Name:GENE
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-6611
Mailing Address - Country:US
Mailing Address - Phone:573-346-2431
Mailing Address - Fax:
Practice Address - Street 1:429 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6611
Practice Address - Country:US
Practice Address - Phone:573-346-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist