Provider Demographics
NPI:1922313121
Name:GORDON, CARL A (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
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 1:1826 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2340
Mailing Address - Country:US
Mailing Address - Phone:504-944-7932
Mailing Address - Fax:504-944-2631
Practice Address - Street 1:1826 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2340
Practice Address - Country:US
Practice Address - Phone:504-944-7932
Practice Address - Fax:504-944-2631
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist