Provider Demographics
NPI:1083666267
Name:GORDON, KAREN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HAZELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2726
Mailing Address - Country:US
Mailing Address - Phone:646-344-2716
Mailing Address - Fax:
Practice Address - Street 1:43 HAZELWOOD LN
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-2726
Practice Address - Country:US
Practice Address - Phone:646-344-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012128183500000X
NYI045161183500000X
NJ28RIO2547900183500000X
VT133.011 6387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist