Provider Demographics
NPI:1740913730
Name:BORDNER, LANDON SCOTT (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:SCOTT
Last Name:BORDNER
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17098-9513
Mailing Address - Country:US
Mailing Address - Phone:717-350-0131
Mailing Address - Fax:
Practice Address - Street 1:4686 STATE ROUTE 209
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023-8478
Practice Address - Country:US
Practice Address - Phone:717-362-9018
Practice Address - Fax:717-362-4014
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPII000090OtherAUTHORIZATION TO ADMINISTER INJECTABLES
PARP456782OtherREGISTERED PHARMACIST