Provider Demographics
NPI:1770187635
Name:MIDGORDEN, JONATHAN MARTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MARTIN
Last Name:MIDGORDEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3234
Mailing Address - Country:US
Mailing Address - Phone:816-225-8421
Mailing Address - Fax:
Practice Address - Street 1:11115 E US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64054-1567
Practice Address - Country:US
Practice Address - Phone:816-833-2493
Practice Address - Fax:816-461-5817
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist