Provider Demographics
NPI:1710087499
Name:GORDAN, RICHARD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:GORDAN
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 1:577 LOCKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6030
Mailing Address - Country:US
Mailing Address - Phone:201-930-8915
Mailing Address - Fax:
Practice Address - Street 1:577 LOCKHAVEN DR
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6030
Practice Address - Country:US
Practice Address - Phone:201-930-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01599200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01599200OtherPHARMACIST LICENSE NUMBER