Provider Demographics
NPI:1003036864
Name:GORDIN, LAWRENCE ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALAN
Last Name:GORDIN
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 1:11462 PEMBROOK RUN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3251
Mailing Address - Country:US
Mailing Address - Phone:239-495-2969
Mailing Address - Fax:
Practice Address - Street 1:20311 GRANDE OAKS SHOPPES BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928
Practice Address - Country:US
Practice Address - Phone:239-495-9013
Practice Address - Fax:239-495-7638
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19132183500000X
VA0202006174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202006174OtherPHARMACIST LICENSE
FLPS19132OtherPHARMACIST LICENSE