Provider Demographics
NPI:1194910117
Name:GORDON, MELVIN (RPH,MPA)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:RPH,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 TRABAJO DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8800
Mailing Address - Country:US
Mailing Address - Phone:800-851-3663
Mailing Address - Fax:800-931-3355
Practice Address - Street 1:2150 TRABAJO DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8800
Practice Address - Country:US
Practice Address - Phone:800-851-3663
Practice Address - Fax:800-931-3355
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH26412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist