Provider Demographics
NPI:1457952590
Name:GORDON, SCOT WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:WILLIAM
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 1:1091 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9157
Mailing Address - Country:US
Mailing Address - Phone:610-530-1514
Mailing Address - Fax:610-530-1532
Practice Address - Street 1:1091 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9157
Practice Address - Country:US
Practice Address - Phone:610-530-1514
Practice Address - Fax:610-530-1532
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034697L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist