Provider Demographics
NPI:1811234891
Name:NARUTA, GORDON P (RPH)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:P
Last Name:NARUTA
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 1:1160 E SR 434
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-2715
Mailing Address - Country:US
Mailing Address - Phone:407-327-9731
Mailing Address - Fax:407-327-9736
Practice Address - Street 1:1160 E SR 434
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2715
Practice Address - Country:US
Practice Address - Phone:407-327-9731
Practice Address - Fax:407-327-9736
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist