Provider Demographics
NPI:1780419796
Name:GORDON, ELIZABETH ANN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1639
Mailing Address - Country:US
Mailing Address - Phone:804-932-8835
Mailing Address - Fax:
Practice Address - Street 1:7300 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1639
Practice Address - Country:US
Practice Address - Phone:804-932-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29499183500000X
VA0202011606183500000X
NY29499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist